Why medical bills are so high

[kallend 2,027]

And it's nothing to do with Obamamcare

healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

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

[airdvr 210]

So true John, and you also know it's nothing Obamacare even comes close to fixing.

Please don't dent the planet.

Destinations by Roxanne

[lawrocket 3]

Brill’s point is to reimburse healthcare the way Medicare does? Seriously? Medicare is, in my opinion, the single most devastating thing that ever happened to health care delivery and payment in the US. Why? Because Medicare is in the business of lowballing payment at all times. The insurance industry then bases its payment schedule on what Medicare pays. Providers end up getting low payments, meaning they have to cram in as many patients as possible to make money.

Medicare pays $11.02 for a CBC test. A private pay patient was charged $157.61 for the payment. The author is basing his entire 25k word writing on the presumption that what Medicare is paying is what the treatment/procedure actually costs or is worth. I’m here to tell you, it ain’t. It barely covers the cost of the damned back office staff who have to do the billings and codings for reimbursement.

Look at what goes into a CBC. Need the sterile place. Needle. Test tube with anticoagulant, phlebotomist, then to the lab where a tech places it into an automated analyzer (those ain’t cheap, nor is even the cleaner used for them) and then the analysis is performed). Medicare has decided that because of budgetary reasons and actuarial predictions based on the use, that it will pay $11.02 for a CBC. It actually costs closer to $20-$25.00. So Medicare reimburses 20 CBCs at $220.04. The actual cost of those CBCs is $400-$500.00. So when a private pay patient comes in, that patient makes up the difference.

Even with Medicare’s miserly reimbursement, Brill notes expected costs of $800 billion this year. Which is an indication of the amount of use (about $72.7 billion CBCs). This happens, of course, when the cost of a service is passed on to someone else.
“Hey, I’ve got this strange stomach pain.”
“Of course, you’re 64 years old. Go get it checked out.”
“I turn 65 in 3 months. Then it’ll be free. I’ll deal with it then.”

Also from the article:

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First, it appears to encourage more procedures and treatment by making them easier and more convenient. (This is especially true for procedures like arthroscopic surgery.) Second, there is little patient pushback against higher costs because it seems to (and often does) result in safer, better care and because the customer getting the treatment is either not going to pay for it or not going to know the price until after the fact.

Brill does not acknowledge the socioeconomic bases of medical care – the tripartite relationship between: (1) cost; (2) quality; and (3) accessibility. You simply cannot have cheap, high quality healthcare available on demand. But that’s what Medicare demands. High quality healthcare on demand that is cheap because we won’t pay much for it.

Why is there very little pushback by patients? Because they aren’t feeling it directly in their pockets. Medicare pays for its patients, so there is no incentive for its members to worry about cost. Taxpayers don’t receive a bill directly – they just pay for Medicare. Insurance companies also pay, meaning that insured don’t fully get an idea of the costs involved. It becomes a commons.

Also note where the big money bills are: not with the physicians but with the hospitals. Huge money. He did a nice job of showing how government’s policy of payment by procedure, etc., is how the payments are made.

What’s my proposal? Get third-party payors out of it except for catastrophic injuries. Save the $900 per month in premiums, make it $200 per month for catastrophic injuries, and put that $700 into an HSA and pay cash. It’ll result in massive layoffs in the health care industry because back-office staff needs are dramatically lower, and the government will lose a couple of hundred thousand employees, and insurance companies will lose a massive number, as well.

Of course it will, in the short term, be bad for the economy. It’s also the opposite of the ACA, which says, “insure everybody.” Adding levels of bureaucracy, more middlemen, and, of course, payment schedules set by the government that don’t reflect the cost of something but just the amount that it has decided it will pay.

"Obamacare" didn't cause it. But it sure as hell is going to perpetuate it. It will bring the total amount spent on healthcare UP.

My wife is hotter than your wife.

[ShcShc11 0]

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So true John, and you also know it's nothing Obamacare even comes close to fixing.

Solution: Public Health Care.

That way, a little white cup (the cups you use to put ketchup) doesn't cost 60,000$ (like it is said from Time magazine) in the U.S, but 0.0008$ in Canada (McGill Montreal Hospital).


But people are stubborn believing capitalism actually brings health care cost down.

[ShcShc11 0]

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"Obamacare" didn't cause it. But it sure as hell is going to perpetuate it. It will bring the total amount spent on healthcare UP.

See Massachussets.
Costs went down btw.

[Andy9o8 2]

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"Obamacare" didn't cause it. But it sure as hell is going to perpetuate it. It will bring the total amount spent on healthcare UP.

See Massachussets.
Costs went down btw.

But that was Romneycare, so that's different

[lawrocket 3]

So when Massachussetts spent $453 million more in health care in 2011 than in 2006, that's not really an increase in the total amount of spending?

How does spending nearly a half a billion more in a state mean "costs went down?" I'm not a mathematician or an economist, so please explain.

My wife is hotter than your wife.

[sfzombie 3]

first of all, most of the cost rise associated with medical bills has to do with malpractice insurance, the higher cost of education, and advertising. it's just like a lawyer to think that it's ok for someone to pay a 400% markup on something just because the government is given a discount.
as to the cost going down in ma, i would assume (having not looked at any figures here) that it was because people could actually get treated now, so the relative decrease in the cost was offset by increasing treatment.

http://kitswv.com

[airdvr 210]

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first of all, most of the cost rise associated with medical bills has to do with malpractice insurance, the higher cost of education, and advertising. it's just like a lawyer to think that it's ok for someone to pay a 400% markup on something just because the government is given a discount.
as to the cost going down in ma, i would assume (having not looked at any figures here) that it was because people could actually get treated now, so the relative decrease in the cost was offset by increasing treatment.

So basically you're guessing?

Please don't dent the planet.

Destinations by Roxanne

[NoCoSkyDiver 0]

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So true John, and you also know it's nothing Obamacare even comes close to fixing.

+ 1

I am surgeon and an owner of a medical practice. I pay for my own health insurance. I pay for over 100 employees health insurance. I also try to get paid by insurance companies. I am really not satisfied with any arrangement.

I do not understand how there is an opinion that obama care is going to save any cost. Please ask yourself this question: How is a bill of mandates and oversight with 2500 pages that nobody really understands (ala Pelosi) going to cut the cost of health care? Obamacare has nothing to cutting the cost of health care, but IMO government power.

I could come up with hundreds of billions of dollars (maybe a trillion) of savings to healthcare with one policy change in medicare. The oversight people in congress know about it, but it really is not about health care dollars, but lobbying.

The whole political system is broken. The only real solution IMO is term limits. People used to go to DC to serve our country at their detriment. Now they go to serve at their benefit and the tax payers detriment.

[maadmax 0]

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And it's nothing to do with Obamamcare

healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

If you tally up all of the people who make their living off of the doctor/patient interaction, insurance companies, lawyers etc, it is no surprise. As a Veterinarian I treat my patients with the same medications, training, professionalism for much less, since I don't have to support a massive organization supposedly adding value to my services.

[GeorgiaDon 362]

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I could come up with hundreds of billions of dollars (maybe a trillion) of savings to healthcare with one policy change in medicare.

Out of curiosity, what would that policy change be?

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[NoCoSkyDiver 0]

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And it's nothing to do with Obamamcare

healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

If you tally up all of the people who make their living off of the doctor/patient interaction, insurance companies, lawyers etc, it is no surprise. As a Veterinarian I treat my patients with the same medications, training, professionalism for much less, since I don't have to support a massive organization supposedly adding value to my services.

+1000, exactly ; you hit part of the problem.

[NoCoSkyDiver 0]

Don will answer tonight or tomorrow when I have more time.

[DiverMike 5]

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As a Veterinarian I treat my patients with the same medications, training, professionalism for much less, since I don't have to support a massive organization supposedly adding value to my services.

That massive organization is caused by legal liabilities. If you mess up Fido's hip replacement, the dog won't sue you. If a doctor messes up grandma's hip, she will sue.

I vote we kill all of the non-skydiving lawyers.

For the same reason I jump off a perfectly good diving board.

[Andy9o8 2]

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I vote we kill all of the non-skydiving lawyers.

Oooh! Sounds just like Hitler.

[wmw999 2,447]

And those legal liabilities are caused in large part by the fact that we value humans more highly than animals. People want the latest, the best, the whatever. Most want to live as long as possible, or they want their loved ones to live as long as possible. Most of the time, if the quality of life has deteriorated enough (and sometimes because the anticipated cost is too high), they put their animals to sleep.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[lawrocket 3]

Allow me to explain the economics of health care policy. This is not just in the US but worldwide.

There are three factors that go into what people want for health care policy: (1) Inexpensive; (2) High quality; and (3) Available on demand. Problem is you can’t have all three of them.

In the US we have a system that is high quality and available on demand, and is therefore expensive. Admittedly, to some extent the care is rationed by the affordability. But if you want to cut the cost of healthcare you have to either decrease the quality or ration the availability of it. Or both ration and decrease quality.

We already can see rationing at work, though. Where is this? Try to get treatment on demand at an emergency room. The state with the shortest average wait is Iowa – and just under 3 hours. It didn’t used to be like this, but thanks to EMTALA, it is well known that a person, if he or she has the time, can get routine care at the local ER without being pressed for payment. The out of pocket cost for this “free health care” is minimal. But the true cost of it is massive. ER’s – where the free care is – rations care by making people wait. The cheaper the care, the lower the quality OR the more it is rationed. ERs are a fine example of it. (Of course, this “free care” knowledge means that real emergencies must be balanced and care for those may be decreased while dealing with the routine cases that routinely come in).

What the President and Congress are seeking to do it move this demand from the ER to a family doctor and create a method of payment for it. This will not lower demand for healthcare. Indeed, it may actually increase it. How many people have said or heard someone say something to the effect that they will refuse treatment that insurance doesn’t cover? By ensuring that more things are covered, more people will seek more care and the costs will increase.

Some here have frequently mentioned that the purpose of the ACA is to deal with the “freeloader.” Yes, it makes the freeloader pay something for what he or she is getting. But it’s also known that the more access is given to care, the more people will use it. Governments – like private insurers – deal with it by either not covering something or by limiting the availability of it.

My wife is hotter than your wife.

[DiverMike 5]

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Oooh! Sounds just like Hitler.

I was trying to sound like Shakespeare.

For the same reason I jump off a perfectly good diving board.

[lawrocket 3]

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If you tally up all of the people who make their living off of the doctor/patient interaction, insurance companies, lawyers etc, it is no surprise. As a Veterinarian I treat my patients with the same medications, training, professionalism for much less, since I don't have to support a massive organization supposedly adding value to my services.

You forgot to add Medicare. The biggest player (by far) in healthcare spending in the US is government. Federal, state and local healthcare spending was $1.1 trillion in 2012. That'll double in the next decade.

A third of every dollar spent on healthcare goes to administrative costs. But not for you because you get paid cash. No need for back office staff to bill. You charge a fee, get paid, and go on.

People, though, won't do that for themselves. They want somebody else to pay for it.

My wife is hotter than your wife.

[wayneflorida 0]

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And it's nothing to do with Obamamcare

healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

If you tally up all of the people who make their living off of the doctor/patient interaction, insurance companies, lawyers etc, it is no surprise. As a Veterinarian I treat my patients with the same medications, training, professionalism for much less, since I don't have to support a massive organization supposedly adding value to my services.

I called my vet to x-ray my foot to see if I had boken my toe. Just could not justify going to some clinic for it although I have insurance.

In and out in about 15 minutes. Broken bone above knucle joint, not displaced, so I just took it easy on that foot for a few weeks. What I figured was wrong but just made sure.

Of course if it was more serious (ankle/knee)I would gone to a doctor.

[Andy9o8 2]

Did he give you a biscuit on your way out?

[maadmax 0]

Of course if it was more serious (ankle/knee)I would gone to a doctor.

[maadmax 0]

People, though, won't do that for themselves. They want somebody else to pay for it.

[maadmax 0]

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Allow me to explain the economics of health care policy. This is not just in the US but worldwide.

There are three factors that go into what people want for health care policy: (1) Inexpensive; (2) High quality; and (3) Available on demand. Problem is you can’t have all three of them.

Total BS. The Vet community does it all the time. Allow Doctors to practice their art without all of the other morons telling them how to do it and amazing things would happen.