Health care costs

[Treejumps 0]

I'm about fed up with the state of politics, but maybe thats just what they ALL want from us so that they can ALL stay in power. Now about the cost of healthcare. If you can pay for health coverage health care is reasonable, and the care you receive is better in the US than anywhere on Earth.

The problem, they say, is that "it" costs too much, and that there are 41 million people without insurance. The only way to bring down the cost is for someone to give up something. Are doctors going to start working for less? No, and for the most part they should not have too. It costs a fortune to get a medical degree and they deserve to live a good life.
So where will the cost savings come from? Yes, I know that some 30% of health dollars go to admin, but even at 10% to admin, good health care costs good money.

So now what do we do with those 41 million uninsured? Why should I have to pay for my insurance and theirs? Why should the gov't (all of us) pay the $80 billion a year to cover their insurance? We live in a capitalist society, and health coverage is available and affordable to those who make it a priority. We already spend billions on helath care for the poor through Medicaid. So what are everyones ideas on this?

THe Democrats currently claim that its the Big Pharma companies fault. (I agree that the US is getting screwed on Rx). The republicans say its the lawyers excessive lawsuits and (outrageous) settelements). There is no question the lawyers need reeled in.

Here is your chance, solve the country's problem.

Cya.

[storm1977 0]

Insurance for Malpractice in parts of California are as high as $100,000 a year!!!!!!!!!!!!!!!!!!!!!!!!!!

How do you expect a doctor fresh out of school with a wife and a couple kids and 200K in student loans +100K in insurance a year to make money?

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Sometimes it is more important to protect LIFE than Liberty

[storm1977 0]

Check this out!!!

http://www.cbsnews.com/stories/2004/04/02/eveningnews/consumer/main610102.shtml

His cost went from 23K/year to 84K/year just for malpractice insurance during a 3 year period!!!!!!!

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Sometimes it is more important to protect LIFE than Liberty

[peregrinerose 0]

Insurance companies are a big part of the problem. I'm an eye doc, so will use eye examples.

Let's say it costs $300/hour to keep my doors open (salaries, utilities, rent, continuing ed, all kinds of insurances, materials, etc) .. and this is hypothetical, I have no idea what it really is. If I sign up with BC/BS, they pay me a whopping $32 per eye exam, no matter how much time I spend with a patient. I'd have to see 10 patients an hour just to meet overhead costs. That cuts down on face to face time with the doc, which gives you shitty care as a patient. This is how a lot of chain optical places stay open, being eye exam mills of crappy care. (I worked in more than one...)

Patients who don't have insurance are charged say $100 an exam, as normal fees. This way I can meet the same overhead with only 3 patients an hour, much better for quality care. However, most patients have insurance.

So how are we supposed to handle it? Insurance companies are out to make money, so pay as little as possible. Docs don't want to lose patients because of insurance coverage, so we have to take at least the major carriers in our areas just to serve our patients. But doing that cuts the income, so we don't meet the bottom line. As a result, we spend less time on patient care, which doesn't make us happy or patients happy. Nobody wins.

A national health care service would actually make this problem far worse. Medicare pays crap and denies so many claims that we often have to write off unpaid fees. I can't imagine that a national health care system would be any better.

Yes, med type schooling is expensive. I pay $2000/month to the student loan people. Well over 1/2 of my pay. I started in debt for $126K, now down to $79K, but at 8% interest, still will be in debt for another 4.5 years.

I had more extra income when I midnight waitressed than I do now as a doctor. How sad is that!!

Jen Galbraith, OD, MS (damn it feels weird to sign that way on here!! Just proving I know a thing or two about this.)

Do or do not, there is no try -Yoda

[PhillyKev 0]

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So now what do we do with those 41 million uninsured? Why should I have to pay for my insurance and theirs? Why should the gov't (all of us) pay the $80 billion a year to cover their insurance?

Because we're all Americans and we all deserve to be healthy if possible and not have our basic healthcare limited by our income.

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THe Democrats currently claim that its the Big Pharma companies fault. (I agree that the US is getting screwed on Rx).

The gov't is the single largest purchaser of medicine. They should use that power to bargain with the pharma companies for better pricing instead of arbitrarily increasing drug expenditures wholesale while allowing the drug companies to raise prices by the same amount or more.

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The republicans say its the lawyers excessive lawsuits and (outrageous) settelements).

Also true. Tort reform is needed across the board.

[Casurf1978 0]

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THe Democrats currently claim that its the Big Pharma companies fault. (I agree that the US is getting screwed on Rx). The republicans say its the lawyers excessive lawsuits and (outrageous) settelements). There is no question the lawyers need reeled in.

It's a variety of issues. If I'm a Pharama comp I will not dump hundreds of millions of dollars on xyz pill only to give it away for pennies on the dollar. It's harsh I know, but if there isnt any profit in it why even persue researching it. Malpractice insurance is also an issue, but like in any profession there are some doctors out there who really dont care about patients, all they want is $$$$. Examples: the MD who left the surgury room to cash his paycheck, I went to a dermatologist for slight acne problem and he wanted to take blood tests and put me on Accutane. Obesity cost our health care system over $75 billion a year. It's a plethora of issues not just one culprit.

[Treejumps 0]

Quote: "Because we're all Americans and we all deserve to be healthy if possible and not have our basic healthcare limited by our income".

That is very a socialistic idea. Nowhere in the constitution, or any other governing document do I see anyhing that says we deserve to be healthy, or have a right to medical care. Besides, why should some people work hard to pay for theri own health care and the health care of others?

[PhillyKev 0]

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That is very a socialistic idea. Nowhere in the constitution, or any other governing document do I see anyhing that says we deserve to be healthy, or have a right to medical care.

You're right, it's not in the constitution that we have a right to medical care. Basic humanity and compassion shouldn't need to be.

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Besides, why should some people work hard to pay for theri own health care and the health care of others?

Why should I pay for highways in Georgia? Oh right, because I'm part of society and society as a whole benefits from it.

By the way, guess who pays for the healthcare of people that can't afford it now. Everyone does in the form of higher costs. And there have been numerous studies to show that lifetime health costs are lower for someone who has regular preventative check ups and office visits than someone who only goes to the hospital for emergencies. In the big picture, we all pay for everyone's health care anyway. Overall it would be cheaper to pay to keep people healthy than to treat the problems they have from poor healthcare over their lifetime.

[Jib 0]

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Yes, I know that some 30% of health dollars go to admin, but even at 10% to admin, good health care costs good money.

How much of it is actually HMO profits?

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the depth of his depravity sickens me.
-- Jerry Falwell, People v. Larry Flynt

[peregrinerose 0]

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I went to a dermatologist for slight acne problem and he wanted to take blood tests and put me on Accutane. Obesity cost our health care system over $75 billion a year. It's a plethora of issues not just one culprit.

They HAVE to do blood tests with accutane because accutane can affect liver function, they need a baseline. Acne is not just about skin, it affects eyelids, oil and tear production, and eventually can cause a bulbous looking nose.

So often the general public thinks we are trying to rip them off when there is real medical reasoning behind the way we do things. Of course, my feeling as a doc is that it is our own damn fault for not spending more time in patient education. Which is why I spend most of my exam time actually talking with and educating my patients, and I always encourage phone calls with questions. It's the most important thing any doc can do for her patients.

But if we could afford to give you more time in the exam room, it would be easier, instead of pumping through patients to meet overhead costs.

Jen

Do or do not, there is no try -Yoda

[Casurf1978 0]

Yeah I know they need blood work for Accutane, but Accutane is for severe cycstic acne, which I dont have. This is what made me worry about this Doctor. Another MD I saw put me on antis and said I did not need Accutane. The Accutane treatment the first doc wanted me on wouldve cost between a couple hundred a month plus $100 for labs.

[kallend 2,027]

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So now what do we do with those 41 million uninsured? Why should I have to pay for my insurance and theirs? Why should the gov't (all of us) pay the $80 billion a year to cover their insurance?

Because we're all Americans and we all deserve to be healthy if possible and not have our basic healthcare limited by our income.

Quote

THe Democrats currently claim that its the Big Pharma companies fault. (I agree that the US is getting screwed on Rx).

The gov't is the single largest purchaser of medicine. They should use that power to bargain with the pharma companies for better pricing instead of arbitrarily increasing drug expenditures wholesale while allowing the drug companies to raise prices by the same amount or more.

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The republicans say its the lawyers excessive lawsuits and (outrageous) settelements).

Also true. Tort reform is needed across the board.

1. The government is specifically prohibited from bargaining with the drug companies under Bush's Medicare act.

2. Bush withheld the cost of the Medicare act from Congress until after the vote.

3. US drug companies are not hurting for profits. In fact they have among the highest profit margins of any US industry. Their profits significantly exceed their research expenditures. They are whining "wolf" when they tell us about how much they have to charge for drugs to pay for the research.

4. A sizeable fraction of the drug R&D is in fact paid for by the government anyway.

...

The only sure way to survive a canopy collision is not to have one.

[lawrocket 3]

There are three things, policywise, to look for in health care:

1) Affordability
2) Availability
3) Quality

IN a sense, this violates standard economic principles. Say you want quality health care at a cheap price. good luck finding it, because it will be rationed.

Or, let's say you want cheap, plentiful health care. It will not be very good,

Or, let's say you want quality healthcare without waiting time. Better have the bucks for it.

I liked peregrine's statement. It's true. Pay cash for a doctor's appointment and they'll work with you. Insurance (like a government pays system) adds a lot of bureacracy and compliance cost to it.

My wife is hotter than your wife.

[SkydiveNFlorida 0]

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So now what do we do with those 41 million uninsured? Why should I have to pay for my insurance and theirs? Why should the gov't (all of us) pay the $80 billion a year to cover their insurance? We live in a capitalist society, and health coverage is available and affordable to those who make it a priority. We already spend billions on helath care for the poor through Medicaid. So what are everyones ideas on this?

Insurance coverage can be very expensive if you are joining as an individual (not part of a 'group'). Now, take a husband with a blue-collar job w/no insurance, a wife who stays home w/ their three young children, and you can easily see how he can't easily afford health insurance for his family. So, let his children die of sickness? Nope. There are programs like Healthy Kids that insure the children of these types of households. And, there is Medicaid for poor adults. Not everyone has the skills to get a good job, and if everyone did, we would have a whole lot of lesser-paying jobs unfilled.

I don't know how to fix it, but I think it is important that everyone be able to seek medical attention. And if that means that I pay a little more so that some kids can go see a doctor, well I can't see the harm in that.

Didn't some President refuse to let us outsource for pharmaceuticals? I understand they are much cheaper from Canada. Maybe i'm mislead.

-A.

[peregrinerose 0]

Good points. The other thing is to tell the freaking doctor. In the exam room, we don't know what insurance you have, or if you have insurance. We treat everyone the same whether you are dirt poor or filthy rich, you get the same amount of time and respect (at least at my practice).

If we don't know that you are in a pinch financially, we don't keep you stocked with sample medications that we get free from the companies to get patients trials of them before prescribing. We don't know that you have 8 starving kids who haven't ever seen a doctor unless you tell us. We are not inhuman beasts out to make a buck.

I just got home, at 8pm tonight, after leaving for work at 630 am. The reason I am home so late is because I drove 2 hours out of my way to see a patient with MS who is homebound and in need of eye care (due to ocular manifestations of MS). I charged him all of $30 to cover gas for my car. That's all I will get for 5 hours of my time. I chose that because I know this family needs the help.

I am signing up for InfanSee, a program where I will be doing FREE eye exams for children under 12 months of age. It will be heavily publicized by Johnson and Johnson beginning next spring. I have given away more low vision aids and exams over the 5 years I've been in practice than I ever really wanted to count. If someone is in need I will take care of them, even if I never get a dime. I encourage patients to donate old glasses to the Lions club. They will be used.

The last doc I worked with spent at least 3 months a year on mission trips. He would see 15,000+ patients in a 2 week period in various contries, providing free eye care and glasses.

I work with area docs who do pro bono work as needed, all I need to do is call, tell them this person has no insurance, no money, but will go blind if they don't get whatever treatment it is they need.

This is the norm in doctors, not the exception. I'm not spewing these examples to make myself look good. I'm doing it to prove a point, that help exists if people make their needs known.

But we can't help if we don't know a problem exists.

Jen

Do or do not, there is no try -Yoda

[rickjump1 0]

Why don't you doctors advertise costs for each service like any other business? How about providing references? Competition is the American way except in areas of medicine or law.

Do your part for global warming: ban beans and hold all popcorn farts.

[Jimbo 0]

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Why don't you doctors advertise costs for each service like any other business?

Do you really want to go to the nearest 'low cost' Dr?

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How about providing references?

Confidentiality? How about asking for references? I've moved more than a few times in the last 5 years. When I want a doctor, I ask around.

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Competition is the American way except in areas of medicine or law.

I think it probably is in law. How many commercials have you seen where lawyers promise to get you money, with no cash up front? Doctors on the hand, most people want the absolute best medical care that they can afford. I don't think that competition is nearly as important as reputation. Looking for a great doctor? Ask around.

-
Jim

"Like" - The modern day comma
Good bye, my friends. You are missed.

[PhillyKev 0]

Good points. And in actuality, it's laziness on the part of consumers.

When I need to find a doctor, I do research and find out where they went to school, what hospitals they're affiliated with, where they did their internship, how long they've been in practice, what their specialties are.

When I see a Dr. I pay my co-pay. Most people stop there and assume it just cost $10 to go to the dr. But when I get the invoice from the insurance company showing what they paid for I read it and see what the actual cost was. You CAN ask for the cost up front, but I'm not even that anal. But I HAVE found charges for tests or bloodwork that didn't take place on bills for routine visits and questioned them.

[rickjump1 0]

most people want the absolute best medical care that they can afford. I don't think that competition is nearly as important as reputation. Looking for a great doctor? Ask around.......
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I want a choice, just like any other business. Please let me decide. I think the law was designed to stop competition in order to keep costs up.

Do your part for global warming: ban beans and hold all popcorn farts.

[peregrinerose 0]

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Why don't you doctors advertise costs for each service like any other business? How about providing references? Competition is the American way except in areas of medicine or law.
dead reckoning vertical

Do you want to go to a business or a doctor? Do you want the cheapest guy in town or the best? Using eye examples, there's a TRUCK in Harrisburg, a freaking semi trailer, that offers $299 LASIK per eye. Same kind of ads from some of the places in Canada. Would you trust your vision to either situation? If you do, hell will freeze over before I take on the responsibility of your follow up care. I could do better LASIK with a flashlight and chainsaw than some of the results I've seen out of these places.

You want references, ask. I'd be happy to send you my CV. I've been published twice while still in school and lectured at the American Academy of Optometry convention, while still in school (EXTREMELY rare for a student to do this). I've been all over the country doing lectures on low vision rehab. I graduated with honors from both undergrad and grad school. My MS degree was paid for with grants due to my background. I chose to do two programs at the same time to be the best low vision doc I could. One of only a small handful of docs with the same credentials. Oh, I worked over 40 hours per week during undergrad, payed my own way at Westminster College. Worked at least 30 hours a week on top of two full time graduate programs at PA College of Optometry. If you call area eye docs, you will hear very good reports on my skills. If you call my patients, they will tell you I pay attention, take my time with them, give them one of the best eye exams they've ever had and am adept at translating doctoreese into English. Plus I never fail to send a patient out blurry as hell from drops but still smiling and laughing.

See how easy that was? All you had to do was ask. You trust us with your bodies, you have the right to ask for credentials, and we have no problem letting you know our backgrounds. The best place to find out who the best is for any field is ask other docs. We see the very best and very worst of other doctors. And we will tell you where to find the best ones. After all, it makes us look really good when you are happy with the care you received from a doc we referred you to.

As docs, we are on YOUR payroll. If you are not happy, fire us and go elsewhere, just have all charts forwarded to the new doc to keep your medical history up to date. It makes our lives far easier knowing how testing came up years in the past rather than having to start from scratch with baselines. Very important with glaucoma, for example.

If you want a second opinion, tell us that, we will refer you to a doc that will provide one you can trust. We don't take it personally, and I often encourage it. If you have a question, call.

There IS competition in medicine. It isn't the same kind of blatant 'buy one bypass surgery get one free' kind of advertising, but it does happen. Check the yellow pages you'll see ads. Doctors often court each other for referrals, making their specialties known. That is where docs often get patients, from other docs. The other place we get new patients is word of mouth from other patients. This is the best advertising I could get.

If 'the best' doc doesn't take your insurance, either switch insurances if possible or talk to the doc personally to find out if other arrangements can be made. I like my neurologist (brain tumor/seizure disorder), but when my insurance changed, he didn't take it. He made life as easy as possible for me so that I could pay out of pocket while still keeping the student loan people happy.

The most important things to remember are:
1. You are in control of your health care. You are the boss.

2. If payment/insurance is a problem, talk to us, we WANT to help people or we wouldn't be in this field. I've never turned a patient away.

3. If you have concerns, research the health condition, ask questions, get second or third or whatever opinions, it is your right. The more you know about your health, the better you can make decisions regarding your own health care.

Do or do not, there is no try -Yoda

[peregrinerose 0]

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But I HAVE found charges for tests or bloodwork that didn't take place on bills for routine visits and questioned them.

This is called insurance fraud and should be reported to the medical board of your state. It is a felony that can be given jail time/high fines/loss of medical license. This kind of thing should not happen. It does happen, but it shouldn't. If your doc is doing this, fire them and go to someone more ethical.

Do or do not, there is no try -Yoda

[PhreeZone 20]

The law? What law?

The one that says Dr X can't start an advertising campaign saying "I cured Rick James (Bitch!) of genital warts for only $39.99 and I was able to repair the damage he did to his man whore for less then $99? Come on down and I'll fix you up for less then $99 too!"

Paient confidenatally laws are a good thing. Trust me, I work in finance and we are locking down our records too, but the medical community with HIPPA is much more strict then we are.

Most Dr's are not accepting new patients right now since they barely have time to treat the ones they have. Wait time to see my Dr right now for non-emergency care is 3 weeks.

When you take your car to be repaired do you ever dispute the labor charge? Does the person that mows your lawn make an itemized bill showing fuel cost, wear on the mower, etc?

Yesterday is history
And tomorrow is a mystery

Parachutemanuals.com

[SkydiveNFlorida 0]

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If we don't know that you are in a pinch financially, we don't keep you stocked with sample medications that we get free from the companies to get patients trials of them before prescribing. We don't know that you have 8 starving kids who haven't ever seen a doctor unless you tell us. We are not inhuman beasts out to make a buck.

That's pretty cool... I didn't know Dr's did that. Sounds like there wouldn't be such issues if more doctors cared about patients, like yourself, rather than just about $$. Don't get me wrong, I don't expect a Doctor to sleep in a crackhouse and help the poor, but a nice gesture now and again is cool, and there are so many doctors that just one nice deed a month would add up. But, this is idealization. Realistically, this won't happen.

Angela.

[peregrinerose 0]

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That's pretty cool... I didn't know Dr's did that. Sounds like there wouldn't be such issues if more doctors cared about patients, like yourself, rather than just about $$. Don't get me wrong, I don't expect a Doctor to sleep in a crackhouse and help the poor, but a nice gesture now and again is cool, and there are so many doctors that just one nice deed a month would add up. But, this is idealization. Realistically, this won't happen.

It does happen a lot. I see it every day because I'm in the field. No doc advertises all the good that they do, primarily because people do abuse it. People hear that we are giving glaucoma meds to the single mom with 6 kids and a minimum wage job, and even though they are single and making enough to make ends meet, they want the same perks.

I have to admit, I'm picky about the people that I give free stuff to, I can't carry everyone, it just isn't possible (again, student loan demons), but I do my best to lend a hand when needed, even when not asked. I had a patient who needed eye patching for amblyopia. Parents couldn't afford the patches at $7 a box. Knowing these people after a few exams with the whole family, I knew they had nothing, but had good hearts. I bought a couple boxes and gave them to the kid. I told the family that I found them lying around the office and they weren't getting used, just so it wouldn't affect their ego.

AND THIS ISN'T JUST ME!!!!!!!!!!!!!! I can't give examples for other docs since it isn't really appropriate, but I've seen everything from testing, exams, medications, even occsasional surgery done for those who TRULY need it.

We are pretty good judges as to who just needs a payment plan and who is truly in need of free help.

Do or do not, there is no try -Yoda

[Jimbo 0]

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That's pretty cool... I didn't know Dr's did that. Sounds like there wouldn't be such issues if more doctors cared about patients, like yourself, rather than just about $$.

Angela, I think what she said was that most doctors do that, but -you- have to let them know that you're in a pinch. Where do you get this idea that doctors don't care about their patients? That is contradictory to what Peregrinerose posted earlier.

-
Jim

"Like" - The modern day comma
Good bye, my friends. You are missed.