The medical system is so corrupt

[ClimbnSink]

The biggest cost driver in American medicine? My guess fat people. #2 Probably the amount of money we spend to save marginal babies and extend the misery of old people. #2 has all sorts of moral implications with no easy answers, well filling out a DNR post age 60 is a start...
But the fat need to pay higher premiums, way higher. Same as sin tax on smokes and alcohol only fat taxes are justified by the costs they incur.

 

[Scrabo]

" It's fairly well accepted that the U.S. is the most expensive healthcare system in the world, but many continue to falsely assume that we pay more for healthcare because we get better health (or better health outcomes). The evidence, however, clearly doesn’t support that view."

http://www.forbes.com/sites/danmunr...ked-dead-last-compared-to-10-other-countries/

 

[Gary F]

The biggest cost driver in American medicine? My guess fat people. #2 Probably the amount of money we spend to save marginal babies and extend the misery of old people. #2 has all sorts of moral implications with no easy answers, well filling out a DNR post age 60 is a start...
But the fat need to pay higher premiums, way higher. Same as sin tax on smokes and alcohol only fat taxes are justified by the costs they incur.

I don't think you are even close.

 

[Henning]

The biggest cost driver in American medicine? My guess fat people. #2 Probably the amount of money we spend to save marginal babies and extend the misery of old people. #2 has all sorts of moral implications with no easy answers, well filling out a DNR post age 60 is a start...
But the fat need to pay higher premiums, way higher. Same as sin tax on smokes and alcohol only fat taxes are justified by the costs they incur.

Pretty much, the biggest cost driver in medicine is keeping people alive that nature is fighting hard to take. If we limited medicine to dealing with quality of life issues than quantity, the entire human race would improve, not just the economy of medicine.

 

[ClimbnSink]

I don't think you are even close.

Fat people, old people, and cardiac cases, which is mostly old fat people.

 

[Everskyward]

That's what he billed the insurance

That may be what he billed, but what did the insurance pay him?

 

[Henning]

I don't think you are even close.

He is correct with the driver, the inefficient administration is a force multiplier.

 

[Gary F]

Fat people, old people, and cardiac cases, which is mostly old fat people.

If you say so. That's not my experience. Cardiac patients come in all sizes where I practice.

 

[ClimbnSink]

If you say so. That's not my experience. Cardiac patients come in all sizes where I practice.

And ages? Pack history?:wink2:

 

[35 AoA]

Or it was the surgeons physicians assitant who may well have been 25 or 27.

you bet, just playing devil's advocate for a second

 

[Henning]

If you say so. That's not my experience. Cardiac patients come in all sizes where I practice.

The problem with cardiac disease is it's immune to normal evolutionary forces, most people have already bred and raised their kids by the time they die from it.

 

[Gary F]

Fat people, old people, and cardiac cases, which is mostly old fat people.

He is correct with the driver, the inefficient administration is a force multiplier.

Old people tend to have more medical problems but I think you overestimate the impact of obesity. Inefficient application of medical services is by far the biggest problem.

And ages? Pack history?:wink2:

They do but there is a bias toward older individuals. The youngest patient I have seen with a heart attack (and not taking illegal drugs) was 16.

 

[Gary F]

The problem with cardiac disease is it's immune to normal evolutionary forces, most people have already bred and raised their kids by the time they die from it.

And cancer and COPD and just about every other disease. Trauma is the leading killer of those who have not yet reproduced and Darwin is often at play here.

 

[Henning]

Old people tend to have more medical problems but I think you overestimate the impact of obesity. Inefficient application of medical services is by far the biggest problem.


They do but there is a bias toward older individuals. The youngest patient I have seen with a heart attack (and not taking illegal drugs) was 16.

Inefficient services is only the immediate direct financial aspect. The big cost factors are in cancer and disease treatments, this block takes up a huge financial block of health care system, and it has an evolutionary cost as well, the consequences of which will likely result in compounding health care costs, not to mention all the rest of the detriment to the species.

But that is the path we have chosen to take, so at this point the only part of the problem we can solve is the application/administration system.

 

[Gary F]

Inefficient services is only the immediate direct financial aspect. The big cost factors are in cancer and disease treatments, this block takes up a huge financial block of health care system, and it has an evolutionary cost as well, the consequences of which will likely result in compounding health care costs, not to mention all the rest of the detriment to the species.

But that is the path we have chosen to take, so at this point the only part of the problem we can solve is the application/administration system.

I don't understand. Of course we spend a lot of money treating disease. That's a fundamental mission of health care. Are you suggesting that we should save money by no longer treating cancer or certain diseases? What if people were willing to spend their own money or buy private insurance and the government stayed out of the picture?

 

[SixPapaCharlie]

That may be what he billed, but what did the insurance pay him?

Good point.
I probably won't know.

The good news I have a max out of pocket which was met with this surgery.
Granted it is near year end but if I had the surgery in Jan and met the max, then I have free health care for the rest of the year.

I really cannot complain about this system. My son was in the hospital today (long story and he is fine now) That will end up being free.

People like to complain about any little thing they can find but had the labs come back different, my son would have gotten an appendectomy today and it would have cost me nothing.

I am not sure how uncommon this is either. Every Job I have had, has had a insurance policy with a max out of pocket of between 3k and 7k

What else in peoples' lives has a max out of pocket and then becomes free?

 

[Henning]

I don't understand. Of course we spend a lot of money treating disease. That's a fundamental mission of health care. Are you suggesting that we should save money by no longer treating cancer or certain diseases? What if people were willing to spend their own money or buy private insurance and the government stayed out of the picture?

Well, that's the thing, and lets forget about the financial impact for the moment. Lets ask, "Is our fundamental mission of health care in the best interest of the future of of our species?"

I personally do not think so, but that is not my decision to make, and it's kinda hard to take away health care, it's a Pandora's Box issue like guns in that manner.

However the decision to use medicine to assure quantity of life beyond natural means rather than to improve quality of life following the natural order comes with costs beyond just those of healthcare, you add in the costs of producing resources beyond nature's capacity to provide them. You also have the cost and consequences of anti-evolutionary processes especially with regards to medicine and children. We want to keep everyone alive as long as it's immediately profitable to do so, but then we have to accept responsibility for keeping them alive, no different from eliminating abortion.

The underlying problem is that you can't operate healthcare to value money and life at the same time. Plus when you start keeping people alive, you become responsible for their lives. My point is that when you start operating healthcare in the 'compassion' model, you have to shift the entire cultural model away from the 'competition' model. This is the evolutionary jump that Jesus was trying to kick start, but failed.

 

[weilke]

Good point.
I probably won't know.

You should get an explanation of benefits (EOB ) that shows what was billed and how much was written off.

The good news I have a max out of pocket which was met with this surgery.
Granted it is near year end but if I had the surgery in Jan and met the max, then I have free health care for the rest of the year.

Keep receipts for everything , you may hit the threshold to deduct the out of pocket health expenses this year.

I really cannot complain about this system. My son was in the hospital today (long story and he is fine now) That will end up being free.

People like to complain about any little thing they can find but had the labs come back different, my son would have gotten an appendectomy today and it would have cost me nothing.

I am not sure how uncommon this is either. Every Job I have had, has had a insurance policy with a max out of pocket of between 3k and 7k

What else in peoples' lives has a max out of pocket and then becomes free?

You are obviously misinformed, dont empathize with the plight of the downtrodden and must have received all your talking points directly from the Koch brothers .

 

[SixPapaCharlie]

You are obviously misinformed, dont empathize with the plight of the downtrodden and must have received all your talking points directly from the Koch brothers .

I don't know what this means.
I just know I am happy to have what I have.

 

[weilke]

I don't know what this means.
I just know I am happy to have what I have.

It means that in recent years anyone who was happy with the health insurance they had was under suspicion of being a paid shill. The people who had to sell something new had to tell us that everything we had sucked and that it needed to get 'improved' under their grand plan.

I understand you are happy with the insurance and access to healthcare you have. So were most people, including me. That was until my health plan was 'improved' from a $300 deductible to a $2500 deductible and from access to uniteds PPO network to everything being out of network. And I work for the insurance company

 

[SixPapaCharlie]

It means that in recent years anyone who was happy with the health insurance they had was under suspicion of being a paid shill. The people who had to sell something new had to tell us that everything we had sucked and that it needed to get 'improved' under their grand plan.

I understand you are happy with the insurance and access to healthcare you have. So were most people, including me. That was until my health plan was 'improved' from a $300 deductible to a $2500 deductible and from access to uniteds PPO network to everything being out of network. And I work for the insurance company

Who cares about deductible?
Did your max out of pocket change?

MOP is the only thing that matters
Deductible is meaningless.

My deductable is $500 yet my surgery cost me personally 3k

People get excited about deductibles. That is the very last thing you should care about when picking a plan.

People need to (because everything needs to be free) ask "How much do I have to spend before my healthcare becomes free?"

I know I was offered different deductibles and an 80/20 or a 90/10
and none of that matters if I have a $2 deduct on a 90/10 or a $1000 deduct on an 80/20 and both plans have a max out of pocket of 3k

Both plans cost the same in the event of anything more than routine dr. visits.

Per Cigna: The deductible is included in the max out of pocket

 

[SixPapaCharlie]

For the record, I am not saying it is not a racket
I worked in insurance for years and barely understood it

I just think we are complaining about something that could be FAR worse.
Our glass is half empty on this one.

 

[weilke]

Who cares about deductible?
Did your max out of pocket change?

Oh it did, it's $12,000

 

[Gary F]

Well, that's the thing, and lets forget about the financial impact for the moment. Lets ask, "Is our fundamental mission of health care in the best interest of the future of of our species?"

Best interest of the species? I don't know. If I had not been taken to emergency surgery at 2 AM one day in August 2006 I would not be here. Since then I have had many good times, supported my family and improved many other people's quality of life and even saved a few from premature death. I also have a chronic autoimmune problem that could cripple me but has been managed well enough that I no longer need a special issuance. I've had some bad experiences but overall medicine has been good to me. Medicine is not practiced efficiently. I'm convinced that over half the money we spend on health care offers no benefit and in some cases results in harm to the patient.

I personally do not think so, but that is not my decision to make, and it's kinda hard to take away health care, it's a Pandora's Box issue like guns in that manner.

However the decision to use medicine to assure quantity of life beyond natural means rather than to improve quality of life following the natural order comes with costs beyond just those of healthcare, you add in the costs of producing resources beyond nature's capacity to provide them. You also have the cost and consequences of anti-evolutionary processes especially with regards to medicine and children. We want to keep everyone alive as long as it's immediately profitable to do so, but then we have to accept responsibility for keeping them alive, no different from eliminating abortion.

The underlying problem is that you can't operate healthcare to value money and life at the same time. Plus when you start keeping people alive, you become responsible for their lives. My point is that when you start operating healthcare in the 'compassion' model, you have to shift the entire cultural model away from the 'competition' model. This is the evolutionary jump that Jesus was trying to kick start, but failed.

I need to think for a while to try to make sense of this.

 

[JOhnH]

Hey, vets are good docs....just don't go to them with a broken leg...

You're talking about horse docs; a small sub set of vets.
Most vets have patched up more broken legs than most MDs. My vet has patched up many of my injuries.

 

[ClimbnSink]

Emergency medicine relating to trauma is the one thing we do well.

 

[azure]

I understand you are happy with the insurance and access to healthcare you have. So were most people, including me. That was until my health plan was 'improved' from a $300 deductible to a $2500 deductible and from access to uniteds PPO network to everything being out of network. And I work for the insurance company

I was quite happy with the insurance I had at my former employer. No deductible, $20 co-pay for physician visits whether generalist or specialist, tiered script co-pays. Hospital fees covered at 100% in-network except for $100 ER visits. Here, for my first half-year I've had an effective $1000 deductible (really $3000, but employer pays $2000 of it), no office visit co-pays (all assuming in-network), out-of-pocket $3000 max. Next year it will be no deductible again but if in-network, $20 co-pay for office visits, 20% co-insurance for all lab work, hospital and surgical fees, radiology (except x-rays done in the doctor's office are covered at 100%, ditto for lab work if not sent out, which is almost never), again tiered pharma co-pays, and out-of-pocket maximum of $4000. That's because employer decided we had it too good relative to other similar institutions and they couldn't continue to afford it. The kicker is that my premiums now will be higher than at my former employer, and we were certainly taking a substantial paycheck cut for that insurance. But here it's not even available as an extra-cost option...

 

[Henning]

Emergency medicine relating to trauma is the one thing we do well.

That is the forte of medicine and IMO where it should lie, especially with a focus on minimizing debilitating results.

 

[weilke]

You're talking about horse docs; a small sub set of vets.
Most vets have patched up more broken legs than most MDs. My vet has patched up many of my injuries.

It was a joke.

 

[JOhnH]

It was a joke.

I knew that. And it was funny.
But I had to respond like I did because my wife is my vet.
There is a cartoon that seems to be a perennial at all vet schools.
It shows a flow chart for horse doctors to use to formulate a treatment plan It had a about a dozen maladies which I don't remember, but it went something like this:

Bloat: Shoot
Wound: Shoot
Broken leg: Shoot
etc etc etc: shoot shoot shoot,

 

[ClimbnSink]

Just remember to walk the horse outside before shooting it.

 

[SixPapaCharlie]

Oh it did, it's $12,000

That's a lot of that.
I'm dodging bullets so far I guess.

We will see what the next gig brings benefit-wise.

 

[paflyer]

In what other industry do you have no idea what services you receive on someone else's say so will cost until they send you on your way?

Why are medical (especially hospital) prices hidden from their customers? Is it perhaps because the medical industry sees insurers as their true customers?

 

[weilke]

I knew that. And it was funny.
But I had to respond like I did because my wife is my vet.

I would be nervous around her with anything beyond a taped ankle

 

[weilke]

In what other industry do you have no idea what services you receive on someone else's say so will cost until they send you on your way?

Thats the nature of getting sick.

Btw, there is always the option to say 'I dont wish to have that CT scan'. But in reality, it is the other way around. Even if the ER doc says: 'junior can weight bear on his ankle, its not gonna be broken, go to urgentcare if he is still limping on monday' parents will insist on the x-ray. People with a known migraine go to the ER expecting to get a CT because this time around it could be a head-bleed. Then add the lawyers into the mix....

Why are medical (especially hospital) prices hidden from their customers?

Ever call the financial services department of a hospital to get the pricing for an elective procedure ? I have done so and obtained the numbers for our cash customers. They are always better off going to a ambulatory surgery center or a private Iimaging center.

I would be fine with a requirement for providers and hospitals having to post pricing for their services. It is difficult to claim that there is a contract between me and a customer that obliges the customer to pay me if there is no reasonable way for the customer to find out what kind of 'consideration' is expected from him at the point in time when he enters Iinto the contract.

Is it perhaps because the medical industry sees insurers as their true customers?

The patients employer is the customer. The insurer is in most cases just an intermediary. You are correct, at least for the insured portion of the market, the patient is not the customer in a market theory sense.

If we went to a 'cash up front and reimbursement from whomever' system (the old indemnity health insurance) the patient would have skin in the game and we would see market forces return.

 

[JHW]

I would be nervous around her with anything beyond a taped ankle

not sure if you can see the scar on my pinkie finger, it actually runs the whole length of the finger from the tip to the base. It was stitched up by a veterinerian in Germany when i decided 3 days was too long to wait for socialized medicine and the private practicioners were also completely booked up.

The vet did a good job. If you can sew up a wriggling, hair-covered cat then a person should be a breeze.

And while I was there, a local dropped by and said "doc, the big dog has a bad cough". The vet rummaged around and asked "do you think the big dog could choke down one of these pills?"

 

[Doggtyred]

While visiting my mother in the hospital this morning, a doctor (not her surgeon, but an "associate" who looked to be about 22) came into her room for less than 1 minute. Based on experiences of friends, I'm guessing this will be billed $200-300. What can you do?

You can say thank you.

I might spend 5 minutes or less at the bedside with a targeted physical exam and questioning, but I will spend 30-40 minutes (or more) on your care. Reviewing the record.. reviewing the labs... prescribing treatments... contacting necessary consultants... talking to your nurse... I'm fortunate that working overnight I have the time to be a detective, and can spend an hour on an admission looking for every last bit of data that may, or may not, be relevant. It helps in the big picture management....

The whole purpose is to get you better. I work with a critical care service in a teaching hospital ICU. We only consult others as truly necessary, and we look at cost versus benefit (i.e. the cheaper option among equally effective treatments)... and try to be responsible stewards.. To be called corrupt shows bias and ignorance.

The staff doctors mentioned earlier.. the "hospitalists"... are the result declining reimbursements and focus on satisfaction scores... Office docs don't have time to keep busy office practices AND round in hospitals...

Busy specialists don't have time to manage EVERYTHING about their patients, just whats pertinent to their specialty.... so the hospitalist takes care of "everything else".

 

[weilke]

not sure if you can see the scar on my pinkie finger, it actually runs the whole length of the finger from the tip to the base. It was stitched up by a veterinerian in Germany when i decided 3 days was too long to wait for socialized medicine and the private practicioners were also completely booked up.

That one got me scratching my head. More typical would be for private practice docs to fall over each other to stitch up a cash-paying 'private patient' (who pays anywhere from 3.5-5 times the government rate). Also, this looks like an injury that would have been entirely legit to walk into the ER (chirurgische ambulanz) for one of the residents to stitch it up. Not sure who advised you there, but it doesn't sound like you got good advice.

The vet did a good job. If you can sew up a wriggling, hair-covered cat then a person should be a breeze.

Again, my comment about being nervous around 'your vet' with anything beyond a taped ankle is not because I doubt any veterinarians skill but for the fear that she may just pull out a rifle and shoot him if she decides that he is beyond help.

 

[Gary F]

That is the forte of medicine and IMO where it should lie, especially with a focus on minimizing debilitating results.

Why? What is your criteria for deciding that trauma care is preferable to other types of medical practice?

 

[JHW]

That one got me scratching my head. More typical would be for private practice docs to fall over each other to stitch up a cash-paying 'private patient' (who pays anywhere from 3.5-5 times the government rate). Also, this looks like an injury that would have been entirely legit to walk into the ER (chirurgische ambulanz) for one of the residents to stitch it up. Not sure who advised you there, but it doesn't sound like you got good advice.

I lived in luxembourg at the time, spent about a third of my time in germany, and my experience that day was typical.