Social Security

[gowlerk 2,190]

53 minutes ago, SethInMI said:

That is overly cynical and overly simplistic.

Perhaps. But what I generally mean is that if they facility has an MRI machine, you will need an MRI. They may not know the prices, but they do know which procedures management is strongly promoting. I'm not saying individual personnel are trying to juice billings. But they have been told what direction to push in.

[SethInMI 174]

3 minutes ago, gowlerk said:

But what I generally mean is that if they facility has an MRI machine, you will need an MRI.

No.

I have been to the ER because I needed stitches in my hand. Did I get an MRI? No. The hospital had one. Have people received unnecessary procedures? Sure. But just saying that happens every time ruins your credibility. Try to be more specific. I have been in hospitals many times for different issues, and only once had an MRI, for back pain on the advice of a neurosurgeon. To say MRIs are handed out like Tylenol is just silly.

 

 

[PhreeZone 20]

14 minutes ago, gowlerk said:

Perhaps. But what I generally mean is that if they facility has an MRI machine, you will need an MRI. They may not know the prices, but they do know which procedures management is strongly promoting. I'm not saying individual personnel are trying to juice billings. But they have been told what direction to push in.

I needed an MRI a few years ago for an injury but it was not a "need it right now in the ER issue" I called my insurance up and found out that the procedure in the hospital was going to cost me $1500 after insurance discount but there was an offsite facility that was 10 miles away that pre insurance pricing was $750 and after discount was $450. I am on a High Deductible Insurance plan so I was going to have to pay the cost out of my HSA / pocket. Before this insurance plan style I would have just done it in the hospital and let the insurance deal with it and paid my low $75 co pay and been done but would have really spent a ton of the insurance companies money, now with the other plan its causing me to be a better consumer and shop around for some options. Here is another example - trip to the ER for a possible broken finger (with possible nerve damage) cost me $2500 - trip to the local urgent care for a fractured ankle - $375 plus the optional 450 for an MRI after the XRays were clear - ER insisted on all those procedures with no opt out option.

[mr2mk1g 10]

2 hours ago, gowlerk said:

Perhaps. But what I generally mean is that if they facility has an MRI machine, you will need an MRI. They may not know the prices, but they do know which procedures management is strongly promoting. I'm not saying individual personnel are trying to juice billings. But they have been told what direction to push in.

My limited experience of US hospitals involved a friend who got too drunk at an after jumping party and passed out and fell backwards out of a porta potty at about midnight.  His also drunk friends called 911 when they couldn't wake him up - well he was black-out drunk and had previously passed out in bed in the bunkhouse.  Two fire trucks and an ambulance turned up and he got carted off to ER.  As one of the responsible adults I went off to the ER to cart him back the DZ where we were staying.  

We arrived to find he'd already had an x-ray and MRI and as we were shown into the room they were currently doing a ultrasound of his abdomen, lord knows why given his history on presentation.  We had to wait for him to sober up as the Dr wouldn't let him be discharged until he'd woken up up but we eventually talked a nurse into letting us just prop him up between us with my mate holding his head up and me waving his arm to the doctor Weekend at Bernie's style. 

Think the nurses had taken a shine to us as while the Dr was doing the ultrasound we were leaning over our friend telling him to 'walk into the light'.  You don't get any sympathy from Brits for drunken injuries, especially not when we have to leave the bonfire to rescue your drunken arse.  And especially not when we know damn well you're absolutely fine.

He ended up with a medical bill of something like $40,000.  All because passed out drunk. Back home he would have, a) probably just been stuck a hospital bed until he sobered up enough to make his own way home given the history on admission and b) it would have been free anyway.

 

Edited April 29, 2019 by mr2mk1g

[gowlerk 2,190]

6 minutes ago, SethInMI said:

No.

I have been to the ER because I needed stitches in my hand. Did I get an MRI? No. The hospital had one. Have people received unnecessary procedures? Sure. But just saying that happens every time ruins your credibility. Try to be more specific. I have been in hospitals many times for different issues, and only once had an MRI, for back pain on the advice of a neurosurgeon. To say MRIs are handed out like Tylenol is just silly.

 

 

Well, now you are being at least as disingenuous as you are calling me. Of course no one could stretch the need for advanced imaging so far as to cover a cut hand. My opinion is mostly based on Canadian skydivers carrying good travel health insurance who have had minor lower body injuries. They often receive imaging diagnostic procedures that leave them astounded by their perception of waste. Billable waste that is.

[SethInMI 174]

8 minutes ago, gowlerk said:

My opinion is mostly based on Canadian skydivers carrying good travel health insurance who have had minor lower body injuries. They often receive imaging diagnostic procedures that leave them astounded by their perception of waste.

That is my point. I know there is waste, but where that is occurring is difficult to tell. I would appreciate any anecdotes as opposed to blanket statements. What injuries got MRIs? Ankle sprain? Knee sprain? How does one tell what is necessary or what is excessive?

[gowlerk 2,190]

1 minute ago, SethInMI said:

That is my point. I know there is waste, but where that is occurring is difficult to tell. I would appreciate any anecdotes as opposed to blanket statements. What injuries got MRIs? Ankle sprain? Knee sprain? How does one tell what is necessary or what is excessive?

Sorry, it's just anecdotal impressions I have gotten over the years. It's my busy time for rigging right now and the only way I could get the details would be to talk to the people who's rigs I should be servicing. I guess the main reason we find it excessive is that MRIs here are generally not available without a much stronger reason and most cases need to be very urgent to get one anywhere near this quickly. But there was one in Eloy last winter that involved a knee sprain, no treatment was needed, but the insurance company paid for an MRI. The others were longer ago and the details are fuzzy in what is left of my mind.

[SethInMI 174]

6 minutes ago, gowlerk said:

But there was one in Eloy last winter that involved a knee sprain, no treatment was needed, but the insurance company paid for an MRI.

That sounds reasonable to me, but like I said earlier, whether that was done out of an abundance of caution / fear of a malpractice accusation, or just to make money is an open question. I think the former is more likely but can be just as wasteful. 

The flip-side of this is also USA medical legend, the tight-fisted insurance company that refuses to allow medically beneficial treatment.

[jakee 1,489]

1 hour ago, billvon said:

Often, no.  Treatments really are better nowadays.  If you broke your femur "way back when" you'd be in traction for weeks, then spend more weeks recovering from the problems caused by being in bed for weeks.  Nowadays they open up your leg, put in an IM rod and let you leave on crutches.  That is, objectively, a much better treatment - but it's surgery.  So a lot of the reason that it's more expensive is that the treatment is both more complex and better.

None of what you just said contradicts my post.

[SethInMI 174]

1 hour ago, PhreeZone said:

I called my insurance up and found out that the procedure in the hospital was going to cost me $1500 after insurance discount but there was an offsite facility that was 10 miles away that pre insurance pricing was $750 and after discount was $450. I am on a High Deductible Insurance plan so I was going to have to pay the cost out of my HSA / pocket.

This is very similar to my own experience with HDHPs and MRIs. I posted about it in a Bonfire thread a few years ago. The blue cross / blue shield insurance company had a "shop around" page on their website that allowed me to compare MRI prices between local hospitals, but their own call center employees didn't know it existed, and no person at any hospital I spoke with could tell me what I would pay if I got an MRI at that facility.

  

[turtlespeed 220]

7 hours ago, billvon said:

Often, no.  Treatments really are better nowadays.  If you broke your femur "way back when" you'd be in traction for weeks, then spend more weeks recovering from the problems caused by being in bed for weeks.  Nowadays they open up your leg, put in an IM rod and let you leave on crutches.  That is, objectively, a much better treatment - but it's surgery.  So a lot of the reason that it's more expensive is that the treatment is both more complex and better.

But yes, there is also a lot of fat in the billing system, which (ironically) was put in place to reduce costs.

Lets not forget about those damned lawyers.

Medical Malpractice insurance is outrageous.

[turtlespeed 220]

6 hours ago, SethInMI said:

No.

I have been to the ER because I needed stitches in my hand. Did I get an MRI? No. The hospital had one. Have people received unnecessary procedures? Sure. But just saying that happens every time ruins your credibility. Try to be more specific. I have been in hospitals many times for different issues, and only once had an MRI, for back pain on the advice of a neurosurgeon. To say MRIs are handed out like Tylenol is just silly.

 

The thing is - you are both right in this. 

I have built ER's - From the freestanding/Privately owned - to the municipal - to ones owned by hospitals.

They all had one thing in common at least:

They installed a CAT scanner - really nice one - and the docs knew and understood the underlying push - that they needed to find ways to utilize it.  They are reasonable about it though.  Stiches on a finger doesnt warrant it.  Although --mostly-- neither does a persistent cough, especially during the height of allergy season . . .  it was a fair bet that a cough got you a cat scan, though. 

[SethInMI 174]

This talk of healthcare costs and controls reminds me of the fact that "50% of health care dollars in this country are spent on 5% of the population". It's really a staggering figure, averaging over $50000 per person per year for the 5%. I wonder how it has changed over the years. A few graphs I found interesting:

In 2017 dollars, USA healthcare spending per capita was $2000 in 1970, and about $11000 now. I wonder how much of that extra cost is going to the 5%. 

https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-on-a-per-capita-basis-health-spending-has-grown-substantially_2017

Health care costs varying with population:

https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/#item-discussion-of-health-spending-often-focus-on-averages-but-a-small-share-of-the-population-incurs-most-of-the-cost_2016

 

[turtlespeed 220]

11 minutes ago, SethInMI said:

This talk of healthcare costs and controls reminds me of the fact that "50% of health care dollars in this country are spent on 5% of the population". It's really a staggering figure, averaging over $50000 per person per year for the 5%. I wonder how it has changed over the years. A few graphs I found interesting:

In 2017 dollars, USA healthcare spending per capita was $2000 in 1970, and about $11000 now. I wonder how much of that extra cost is going to the 5%. 

https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-on-a-per-capita-basis-health-spending-has-grown-substantially_2017

Health care costs varying with population:

https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/#item-discussion-of-health-spending-often-focus-on-averages-but-a-small-share-of-the-population-incurs-most-of-the-cost_2016

 

Sounds like this:

	Top 1%	Top 5%
Income Taxes Paid ($ millions)	$538,257	$839,898
Share of Total Income Taxes Paid	37.32%	58.23%
Income Split Point	$480,804	$197,651
Average Tax Rate	26.87%	23.49%

[SkyDekker 1,465]

20 minutes ago, turtlespeed said:

Sounds like this:

	Top 1%	Top 5%
Income Taxes Paid ($ millions)	$538,257	$839,898
Share of Total Income Taxes Paid	37.32%	58.23%
Income Split Point	$480,804	$197,651
Average Tax Rate	26.87%	23.49%

I wish my average tax rate was that low.

But then an illness won't bankrupt me.

[turtlespeed 220]

16 minutes ago, SkyDekker said:

I wish my average tax rate was that low.

But then an illness won't bankrupt me.

Trade offs for everything.

[gowlerk 2,190]

1 hour ago, SethInMI said:

This talk of healthcare costs and controls reminds me of the fact that "50% of health care dollars in this country are spent on 5% of the population".

Yes, if we euthanized sick people healthcare costs would fall dramatically. Even more if we could catch them before they breed.

[SethInMI 174]

16 minutes ago, gowlerk said:

Yes, if we euthanized sick people healthcare costs would fall dramatically. Even more if we could catch them before they breed.

True. But eventually any of us could take a turn as one of the 5%. If the 5% level is a 50k bill, being part of the that group is having a single battle with cancer or just a badly mis-judged swoop.

The Atlantic had a article about the chronic 5%'ers, those who year after year are in that group, and the focus that some states are putting on them to try and get their cost of care down, which makes sense to me, try to bring attention to the big recurring costs. I mention that 5% not because I want to kill them off, but because theirs is the greatest room for improvement. If you have someone who is costing 50k a year, year after year, getting that down to 40k or 30k could have massive savings. If all the 50k is necessary of course, well there isn't anything to do, but the article pointed out cases where in fact by giving those people intensive in-home attention it could keep them out of the hospital where the big bills get run up.

[turtlespeed 220]

39 minutes ago, SethInMI said:

I mention that 5% not because I want to kill them off, but because theirs is the greatest room for improvement.

Lets be honest - 

[BIGUN 1,306]

3 hours ago, gowlerk said:

Yes, if we euthanized sick people healthcare costs would fall dramatically. Even more if we could catch them before they breed.

And, there you have it. The liberals future agenda on abortion. 

[kallend 2,026]

Friend of mine had a heart attack on April 2.  Admitted to ICU. Complications due to diabetes.

Following 3 open heart surgeries he died April 15 without ever leaving the ICU.

Last 13 days of his life racked up some $500,000 in medical bills.  A very expensive 13 day extension.

[BIGUN 1,306]

11 hours ago, gowlerk said:

Even more if we could catch them before they breed.

Quote

And, there you have it. The liberals future agenda on abortion.

Gowlerk, I want to apologize for this comment. It really wasn't directed at you per se. I've been doing a lot of homework lately on the whole abortion issue and - quite frankly am getting pissed off at both sides on this. But, that's an issue for another thread. Anyway - my apologies for getting too close to the line. . 

Edited April 30, 2019 by BIGUN

[gowlerk 2,190]

1 minute ago, BIGUN said:

Gowlerk, I want to apologize for this comment. It really wasn't directed at you per se.

It's okay, no offense was taken. My comment that you replied to was tongue in cheek, sarcastic and fully deserving of  your reply. I would advise you to not think too much about abortion. It hurts the head.

[BIGUN 1,306]

Just now, gowlerk said:

I would advise you to not think too much about abortion. It hurts the head.

That is no shit. Thanks.

[Coreece 190]

7 minutes ago, gowlerk said:

I would advise you to not think too much about abortion. It hurts the head

Ya, just stick it in the sand.