More fun with for-profit medicine

[thriftyandboringinohio]

Re: More fun with for-profit medicine

1.)

Occasionally, I find scorpions in my shoes or in the bathroom. There are over a thousand species and most are not deadly. Interesting reads…wondering why the hospital couldn’t have bought the anti venom from Arizona State University.

http://egofelix.com/8818-surviving-the-scorpion-sting

http://flatrock.org.nz/topics/animal...e_of_death.htm

2.)

With so few people getting stung and most not needing the anti venom, drug companies normally couldn’t make a buck, but of course in the USA it's another story.

It’s quite appropriate for public universities to take on the task.

"After the Food and Drug Administration approved the drug last year, Tennessee-based Rare Disease Therapeutics sold the drug to a distributor for $3,500 per dose. Hell, why not $18,000?

Once again, it highlights how absurd prices can become when there's no way of knowing what things should cost.

Would you pay 3,500 or 37,000 dollars for a chain saw, a guitar lesson, or a tulip bulb?

Great insights, Thai.

My remark was towards lektrode suddenly dragging Al Gore into this discussion.

[Raz]

Re: More fun with for-profit medicine

Another reason the system as it stands can't go on. The lack of restraint is amazing. Nothing worse than taking advantage of someone with a medical emergency. What's next? " Have sex with me or I'll let you die"? Stories like this confirm my gut instincts that the "big business" side of our healthcare system holds most of the blame for rising costs. The usual rules of business simply cannot apply in life and death situations. Can't wait until they privatize Police and Fire. " Oh, you're being raped? $50 grand and we'll be right out."

Just one of the reasons I was forced to abandon my free market principles concerning the healthcare industry. (Along with the intelligent and civil discussion by dcarrigg.)

[lektrode]

Re: More fun with for-profit medicine

That sure came our of nowhere, apropos of nothing.

what do you mean, 'apropos of nothing'?
moving along...

Great insights, Thai.

My remark was towards lektrode suddenly dragging Al Gore into this discussion.

yes - i agree = great insights....
esp these:

...

"After the Food and Drug Administration approved the drug last year, Tennessee-based Rare Disease Therapeutics sold the drug to a distributor for $3,500 per dose. Hell, why not $18,000?

Once again, it highlights how absurd prices can become when there's no way of knowing what things should cost.

Would you pay 3,500 or 37,000 dollars for a chain saw, a guitar lesson, or a tulip bulb?

or 'carbon-offset credits'....

my comment was based upon the mention of a TN-based co. 'profiteering' on some critical medical proceedure - not unlike what al gore/kleiner-perkins&co is doing with/to the energy biz - perhaps a bit offtrack on this one - but hey!

but.... since you asked T&B: why is THIS thread any diff than most of the others (here in 'the news') that get WILDLY off-topic, all the time?

but this is interesting:

http://www.azcentral.com/business/ar...drug-cost.html

Blue Cross Blue Shield of Arizona, the state's largest private insurance company as measured by premiums, said it is still evaluating the new treatment.


The insurer will establish a fee for the drug once insurance codes are developed by the American Medical Association and a private company called Practice Management Information Corp.


Once the billing codes are established, Blue Cross Blue Shield will review medical literature and determine whether coverage should be limited to certain groups of patients such as children and the elderly.


The drug may be a hot-button issue for the state's Medicaid system, the Arizona Health Care Cost Containment System. Rare Disease Therapeutics estimates that 40 percent of Anascorp doses will be given to patients enrolled in the state's insurance program for low-income residents.


Alag�n, who conducted research on the serum in Mexico, said he is surprised when people ask him whether he is making a lot of money now that the drug has reached the U.S. He explains that he has no control over the price of the drug and gets no financial benefit.


"We, as a country, lost control of our products," Alag�n said. "I am upset about that, especially because they are charging so much. They are not being sensitive."

yeah, and since 40% of it will goto 'low income' residents, who wont ever actually see a bill for it - then they can REALLY whack the price, since the .gov (read: The Rest of US) will get stuck paying thru the nose for it...
kinda like what ole unkle al and kleiner-perkins are bankin on....

and even tho it looks like this is a very handy to have around substance ?
i still say it smells kinda like the whole carbon-trading scam = just another FIre-fueled payday for the cronies, that while it 'sounded like a good idea' at the time' is just MORE OF THE SAME, from The Usual Suspects

but sorry for the distraction.

[Raz]

Re: More fun with for-profit medicine

1.)

Occasionally, I find scorpions in my shoes or in the bathroom. There are over a thousand species and most are not deadly. Interesting reads…wondering why the hospital couldn’t have bought the anti venom from Arizona State University.

http://egofelix.com/8818-surviving-the-scorpion-sting

http://flatrock.org.nz/topics/animal...e_of_death.htm

... Once again, it highlights how absurd prices can become when there's no way of knowing what things should cost.

Would you pay 3,500 or 37,000 dollars for a chain saw, a guitar lesson, or a tulip bulb?

How much will people pay for one of Timmy Geithner's 10-year Treasury Notes? This Bernanke Bond Market is another example of price absurdity.

[DSpencer]

Re: More fun with for-profit medicine

what do you mean, 'apropos of nothing'?

It means you're making off topic comments so that you have an excuse to sling mud on Al Gore.

yeah, and since 40% of it will goto 'low income' residents, who wont ever actually see a bill for it - then they can REALLY whack the price, since the .gov (read: The Rest of US) will get stuck paying thru the nose for it...

So you believe that hospitals can charge medicaid any amount and then collect full payment?

[flintlock]

Re: More fun with for-profit medicine

It sounds like so far she has paid nothing out of pocket. I doubt she will pay that bill either. Some hospitals go through the motions of balance billing the patient but purposely avoid any real collection effort. Post a follow up if the patient ever actually pays her bill and it will make the comment more credible. Yes I realize the media will likely never follow up in either case.

Just to be clear, I'm not defending the current system and I'm not saying this is a fair price. But comparing the cost of the goods to the bill is like complaining that you paid a lawyer 1000 dollars for a contract that only used 10 pieces of paper and some ink. Healthcare in the US is a game. You have to know the rules to have any hope of understanding what's happening.

As a side question, per the title of the thread: is the hospital a "non-profit"?

And the hospital writes off the non-payment as a loss of course.

It really is a game isn't it. I got a letter the other day from my insurance saying they were dropping my doctor from my plan. I asked my doc about it the next time I went in. he said, " aw, we are just playing chicken with each other". Sure enough, after a few weeks with no doctor, a letter arrives saying he's back in plan. I was literally minutes from finding another doctor.

The current US healthcare system is like trying to drive with a different set of rules in each State. You drive on the right in GA, on the left in SC. At some point leadership is needed to step in and standardize things. Congress seems unwilling or unable.

[flintlock]

Re: More fun with for-profit medicine

Yes but the hospital would never tell her up front what it would cost! That ruins everything! Also the doctors most likely wouldn't even know what the hospital would charge.

Exactly. I remember having to cancel a nerve block procedure at the last minute because they literally could not or would not tell me what it cost. This is a month after it was scheduled! Sorry, but no blank checks from me. There is a serious disconnect between the business end of medicine and the medical end. I know its complex but why can't they just charge the same for everyone, fire the staff who have to sort all this out, and we all pocket the savings?

[Thailandnotes]

Re: More fun with for-profit medicine

Article below was in the August New Yorker. Written by a doctor. I have a IT friend at a big hospital. His horror stories about the waste and stupidity of conflicting systems are described in the article. Basically, he is on call forever until he quits and finds another job.

http://www.newyorker.com/reporting/2...urrentPage=all

It was Saturday night, and I was at the local Cheesecake Factory with my two teen-age daughters and three of their friends. You may know the chain: a hundred and sixty restaurants with a catalogue-like menu that, when I did a count, listed three hundred and eight dinner items (including the forty-nine on the “Skinnylicious” menu), plus a hundred and twenty-four choices of beverage. It’s a linen-napkin-and-tablecloth sort of place, but with something for everyone. There’s wine and wasabi-crusted ahi tuna, but there’s also buffalo wings and Bud Light. The kids ordered mostly comfort food—pot stickers, mini crab cakes, teriyaki chicken, Hawaiian pizza, pasta carbonara. I got a beet salad with goat cheese, white-bean hummus and warm flatbread, and the miso salmon.

The place is huge, but it’s invariably packed, and you can see why. The typical entrée is under fifteen dollars. The décor is fancy, in an accessible, Disney-cruise-ship sort of way: faux Egyptian columns, earth-tone murals, vaulted ceilings. The waiters are efficient and friendly. They wear all white (crisp white oxford shirt, pants, apron, sneakers) and try to make you feel as if it were a special night out. As for the food—can I say this without losing forever my chance of getting a reservation at Per Se?—it was delicious.

The chain serves more than eighty million people per year. I pictured semi-frozen bags of beet salad shipped from Mexico, buckets of precooked pasta and production-line hummus, fish from a box. And yet nothing smacked of mass production. My beets were crisp and fresh, the hummus creamy, the salmon like butter in my mouth. No doubt everything we ordered was sweeter, fattier, and bigger than it had to be. But the Cheesecake Factory knows its customers. The whole table was happy (with the possible exception of Ethan, aged sixteen, who picked the onions out of his Hawaiian pizza).

I wondered how they pulled it off. I asked one of the Cheesecake Factory line cooks how much of the food was premade. He told me that everything’s pretty much made from scratch—except the cheesecake, which actually is from a cheesecake factory, in Calabasas, California.

I’d come from the hospital that day...

[BadJuju]

Re: More fun with for-profit medicine

Exactly. I remember having to cancel a nerve block procedure at the last minute because they literally could not or would not tell me what it cost. This is a month after it was scheduled! Sorry, but no blank checks from me. There is a serious disconnect between the business end of medicine and the medical end. I know its complex but why can't they just charge the same for everyone, fire the staff who have to sort all this out, and we all pocket the savings?

It is amazing how much you have to fight to find how much it will cost you. They don't want to pony up until after you are done and then they lay down a massively inflated bill.

[lektrode]

Re: More fun with for-profit medicine

It means you're making off topic comments so that you have an excuse to sling mud on Al Gore.

au contraire, mon ami - i dont need any more excuses to sling mud on ole unkle al than what he has already provided... and that - without any 'help' from me - could be referred to as 'an embarrassment of riches'

my comment was geographical in nature, as in a 'Tenn-based' drug co... (as is unkle al, a Tenn-based member of the political aristocracy)

So you believe that hospitals can charge medicaid any amount and then collect full payment?

uhhh... no.... guess you dont ready many of my posts.

my point was that some drug co buys some drug from mexico - where it sells for 100bux/dose - marks it up in Tenn to 3800bux and then some hospital in Ariz sells it for 38 THOUSAND - whereupon i made reference/connection to the 'business' of buying/selling 'carbon-offset credits' - essentially by forcing The Rest of US to pay more for energy, so that people like gore,kleiner,perkins et al get to make 10s to 100s of millions while putting forth the charade that this will help 'global warming'

which to me sounds just like a hospital colluding with a med-ins outfit to gouge the public for 37000 on something a Tenn-based outfit buys in mexico for a 100.

and THEN we discover that the Tenn-based outfit has determined that 40% of sales will goto 'low income' and likely non-legal/low-income people at that = just MORE OF THE SAME FROM THE CROWD GORE & CO 'represent'.
and In The Name of 'helping the disadvantaged' - since if the hospital/ins co get to 'save lives of the low-incomed' then they must feel somehow entitled to collect windfall profit margins? (like gore,kleiner,perkins apparently feel entitled to for 'saving us' from global warming....)

all the while making millions from gouging The Rest of US in areas where most have No Choice but to knuckle under and pay it and/or the .gov gets the bill?

no sir - I DONT THINK THATS OK

[flintlock]

Re: More fun with for-profit medicine

It is amazing how much you have to fight to find how much it will cost you. They don't want to pony up until after you are done and then they lay down a massively inflated bill.

Why not. I'd love to just bill my customers after the fact. Who wants to have to negotiate? Or compete. That can be unpleasant. I'm convinced a serious dent could be put in rising costs if they would just be required to post fees up front. It would have a serious chilling effect on price inflation. But there is a lot more to the problem of course.

[shiny!]

Re: More fun with for-profit medicine

Exactly. I remember having to cancel a nerve block procedure at the last minute because they literally could not or would not tell me what it cost. This is a month after it was scheduled! Sorry, but no blank checks from me. There is a serious disconnect between the business end of medicine and the medical end. I know its complex but why can't they just charge the same for everyone, fire the staff who have to sort all this out, and we all pocket the savings?

Absolutely right!

I had to go to the ER for "female troubles" about nine years ago, where I was referred to an OB/GYN who saw me the next day. She said I needed surgery and we discussed my options. We decided on an outpatient procedure that she said had the best outcome. The day before my surgery was scheduled, Blue Cross refused to cover the procedure. They would only cover an inferior, less expensive procedure, one that has a high percentage of cases where the problem recurs and the patient has to undergo another surgery. They told me that if that happened, I could have the surgical procedure my doctor and I wanted to do in the first place.

The next day, the doctor, anesthesiologist, and surgical nurse had a conference around my bed in the pre-op ward. They all agreed that I should have the better procedure so I wouldn't have to come back again. They conspired to do it in a way that could not be detected by the hospital bean counters. My doctor did a more complicated procedure without getting paid for it because she wanted to give me the best care.

****************

The following year, my husband needed a hip replacement. He told his surgeon on three separate occasions, including in the pre-op ward, to not use anyone for the procedure who was not in our insurance network. The doctor promised he would stay in-network.

About six months after the surgery, when it seemed like we should have paid off all our deductible, we were still getting a monthly bill from the surgeon's office. I called them to see what it was about. Turns out they were billing us for the assistant surgeon. Who was Out-of-Network. Who was present in the surgeon's office when my husband very clearly told them to not use anyone in procedure who was not in the Blue-Cross network. Who deliberately failed to disclose his Out-of-Network status at the time, and assisted in the surgery anyway. Who wanted to be paid the enormous Out-Of-Network fee. We told him where he could stuff his bill.

****************

When my husband had emergency heart surgery in '08, all the doctors and labs allowed us 12-24 months to pay. Except for the hospital itself. We told them they would have to be patient but they insisted on being paid in full within 90 days. After 90 days they sent us to collections even though we were paying them every month. We told them where they could stuff their bill.

****************

About two years ago my physician's assistant (I've never seen my doctor) found a mass on my thyroid. Needed a biopsy. I called United Healthcare twice to try to find out how much I would be paying out of pocket. I gave them the procedure codes and carefully wrote down their answers. Asked them repeatedly if that was ALL. If there were any other charges I didn't know about. When I checked in to the hospital for the biopsy, I very carefully made addendums to the intake papers stating that I would not pay for any Out-of-Network providers. Then the hospital staff said my responsibility would be $2000 more than what United Healthcare had told me. I argued with them for over an hour. Called UHC and got the runaround. Spent 45 minutes on the phone arguing with my insurance company. The hospital wanted me to hurry up because I was throwing their schedule off.

UHC told me that the error occured because the woman I had spoken to was new on the job and had omitted the price for one of the codes I gave them. They took no responsibility for having poorly trained staff giving out wrong information.

When it was all over, the doctor who performed the fifteen-minute biopsy was paid four times as much as my surgeon who performed a four-hour hemithyroidectomy.

****************

There are no words for how much I hate this system.

[lektrode]

Re: More fun with for-profit medicine

....

When it was all over, the doctor who performed the fifteen-minute biopsy was paid four times as much as my surgeon who performed a four-hour hemithyroidectomy.

****************

There are no words for how much I hate this system.

+1
and this is one of my primary complaints: it would appear that the price of any given proceedure or treatment has no connection whatsoever to the actual costs involved in delivering said treatment

for instance: my med ins coverage charges me a $1500 'copay' for a CTscan (this is on top of the nearly 6grand/year for the premiums, or 'dues' as they like to call em)

now i flatly refuse to believe that it costs them anywhere near even 1/4 of that to actually deliver a CTscan - never mind the stated 'price' of 3000 - not when the use of this eqpt negates the necessity of surgery when a closer look at ones inards is indicated - it seems to me they are charging for the 'avoided costs' of surgery, when they quote 3grand for a 20min proceedure, that thusly reduces their costs of diagnosis (vs opening us up for a looksee)

and it also would appear that these things have become profit generators rather than 'lifesavers' as their usage has tripled

but i'm still of the opinion that the reasons behind all this price gouging has more to do with state-mandated coverage of things that should NOT be 'insurable events' (like routine maternity, birth control, viagra, substance abuse therapy, sexchange therapy yada yada yada, etc, ad nauseum...) and the practice of CYA medicine, thanks to the jackpot justice mentality celebrated by the tort bar - all of which just piles on costs that the insurers then use to pad their profit margins with.

[DSpencer]

Re: More fun with for-profit medicine

uhhh... no.... guess you dont ready many of my posts.

my point was that some drug co buys some drug from mexico - where it sells for 100bux/dose - marks it up in Tenn to 3800bux and then some hospital in Ariz sells it for 38 THOUSAND - whereupon i made reference/connection to the 'business' of buying/selling 'carbon-offset credits' - essentially by forcing The Rest of US to pay more for energy, so that people like gore,kleiner,perkins et al get to make 10s to 100s of millions while putting forth the charade that this will help 'global warming'

which to me sounds just like a hospital colluding with a med-ins outfit to gouge the public for 37000 on something a Tenn-based outfit buys in mexico for a 100.

and THEN we discover that the Tenn-based outfit has determined that 40% of sales will goto 'low income' and likely non-legal/low-income people at that = just MORE OF THE SAME FROM THE CROWD GORE & CO 'represent'.
and In The Name of 'helping the disadvantaged' - since if the hospital/ins co get to 'save lives of the low-incomed' then they must feel somehow entitled to collect windfall profit margins? (like gore,kleiner,perkins apparently feel entitled to for 'saving us' from global warming....)

all the while making millions from gouging The Rest of US in areas where most have No Choice but to knuckle under and pay it and/or the .gov gets the bill?

no sir - I DONT THINK THATS OK

You come across as a friendly person on these boards so sorry if this offends you, but you asked. I do read many of your posts. I sometimes skim them as they are usually unnecessarily long, filled with seemingly intentional spelling and grammatical errors and are typically just long rants instead of thoughtful discussion. For example the above rant has almost nothing whatsoever to do with the quote of yours that I referenced:

yeah, and since 40% of it will goto 'low income' residents, who wont ever actually see a bill for it - then they can REALLY whack the price, since the .gov (read: The Rest of US) will get stuck paying thru the nose for it...

How this could mean anything other than a belief that the hospital will be able to set the price high and get huge payments from the ".gov" which would be Medicaid in this instance?

So it's a simple question: Is this how you personally believe the Medicaid program works? Yes or no would be a concise way to answer.

Instead you imply that I need to read tons of your old posts to understand what you mean. And then you start going on again about how this somehow relates to Al Gore/carbon credits because one part of the story mentions Tennessee and you think they are both scams. I also think Al Gore is a lying thief and carbon credits are a scam. That doesn't mean that it has any meaningful connection to the price of scorpion anti-venom or the amount that Medicaid reimburses.

I come to itulip because, for the most part, the members seem genuinely interested in the truth above propaganda. I feel that these over-the-top and off-topic posts belong in the rant and rave forum or on another site. Maybe I'm just boring and other people have more appetite for the extra flavor.

[lektrode]

Re: More fun with for-profit medicine

You come across as a friendly person on these boards so sorry if this offends you, but you asked. I do read many of your posts. I sometimes skim them as they are usually unnecessarily long, filled with seemingly intentional spelling and grammatical errors and are typically just long rants instead of thoughtful discussion. For example the above rant has almost nothing whatsoever to do with the quote of yours that I referenced:



How this could mean anything other than a belief that the hospital will be able to set the price high and get huge payments from the ".gov" which would be Medicaid in this instance?

So it's a simple question: Is this how you personally believe the Medicaid program works? Yes or no would be a concise way to answer.

Instead you imply that I need to read tons of your old posts to understand what you mean. And then you start going on again about how this somehow relates to Al Gore/carbon credits because one part of the story mentions Tennessee and you think they are both scams. I also think Al Gore is a lying thief and carbon credits are a scam. That doesn't mean that it has any meaningful connection to the price of scorpion anti-venom or the amount that Medicaid reimburses.

I come to itulip because, for the most part, the members seem genuinely interested in the truth above propaganda. I feel that these over-the-top and off-topic posts belong in the rant and rave forum or on another site. Maybe I'm just boring and other people have more appetite for the extra flavor.

well thanks for thinking i'm a 'friendly person' an all, since i do try to be - and yeah, i guess i do tend to rant/rave on some topics - esp on some of the more politically charged posts, here in The News (an open forum, NOT behind the paywall) - and tho i wouldnt go as far as being appreciative of it - hey, thanks for your critique on my posting style - altho i could take offense at your comments, i cant be bothered with wasting my time on such and always marvel at those who take it upon themselves - nay - go out of their way to tell others how they think we should behave.

oh and sorry for not making my attempt at sarcasm more clear: obviously i dont think thats how the medicaid program should work (hospitals charging 38000bux for something the distributor/vendor pays the manufacturer 100 for) and i simply made a comparison to another of the programs the fans of bigger gov think we should be embracing.

and i try not to be boring.

oh and appologies to the folks from Tennessee if i've offended any of them