More fun with for-profit medicine

[lakedaemonian]

Re: More fun with for-profit medicine

your post

Wow....I'm at a loss for words......


I did like that article on the Cheesecake Factory.....good choice......as that place seems to have a huge amount of complexity in it's menu breadth/depth, in it's volume, in it's consistency, in it's innovation with an ever changing menu, and it's ability to accurately predict/forecast demand and minimize waste.....all while making a profit and offering perceived high value.

Why can't the healthcare industry provide the same?

[shiny!]

Re: More fun with for-profit medicine

Wow....I'm at a loss for words......


I did like that article on the Cheesecake Factory.....good choice......as that place seems to have a huge amount of complexity in it's menu breadth/depth, in it's volume, in it's consistency, in it's innovation with an ever changing menu, and it's ability to accurately predict/forecast demand and minimize waste.....all while making a profit and offering perceived high value.

Why can't the healthcare industry provide the same?

Maybe lack of competition? Restaurants have a lot of competition, insurance companies not so much.

Seems like the system itself causes high expenses- even if the insurance companies weren't greedy. All the extra admistrative staff and paperwork necessary for billing and filing claims are costly. Remember the days when you walked into your doctor's office and paid cash? I do.

Remember when health insurance existed to keep people from going broke in case of a medical catastrophe? Now it is the thing that causes people to go broke.

[lektrode]

Re: More fun with for-profit medicine

Maybe lack of competition? Restaurants have a lot of competition, insurance companies not so much.

Seems like the system itself causes high expenses- even if the insurance companies weren't greedy. All the extra admistrative staff and paperwork necessary for billing and filing claims are costly. Remember the days when you walked into your doctor's office and paid cash? I do.

Remember when health insurance existed to keep people from going broke in case of a medical catastrophe? Now it is the thing that causes people to go broke.

+1
med ins premiums (or 'dues' like it was some kind of health club) will be my largest single expense this year, likely more than taxes.

competition?
it doesnt exist - mostly due to zero price 'discovery' and price fixing/collusion runs rampant - see the profit to be had on ONE item alone, above

while i have some reservations regarding 'single payer' (tho they are dwindling by the month) - the real problem is mostly due to 3rd-party payment systems that have caused the consumer to not pay attention to the charges - so...
i keep coming back to the concept of a 6th branch of the military called The Medical Corps, that would essentially be an expansion of the VA system - that would provide the ultimate safety net to those who havent any other options.

it could be staffed by those who want to get educated in the medical fields, but DONT want to go 150grand or more into debt to pay for it and then would owe uncle sam some period of years of service

why is this one so hard for the beltway to even discuss is likely due to the med/edu-industrial complex, the banksters profits associated with maintaining of the status quo, along with the 400 billion/year being skimmed off by the system - as well as the beltway aristocracy being bought-off by it, since they dont pay any where near what The Rest of US get charged

again TERM LIMITS FOR CONGRESS will be a major part of the solution.

[DSpencer]

Re: More fun with for-profit medicine

Wow....I'm at a loss for words......


I did like that article on the Cheesecake Factory.....good choice......as that place seems to have a huge amount of complexity in it's menu breadth/depth, in it's volume, in it's consistency, in it's innovation with an ever changing menu, and it's ability to accurately predict/forecast demand and minimize waste.....all while making a profit and offering perceived high value.

Why can't the healthcare industry provide the same?

Not denying any of that , but have you ever looked at the nutrition info for cheesecake factory? Its off the charts. Some items are a full days worth of calories and multiple days worth of saturated fat. If people stopped eating there that would probably solve the healthcare crisis (kidding).

[lakedaemonian]

Re: More fun with for-profit medicine

Not denying any of that , but have you ever looked at the nutrition info for cheesecake factory? Its off the charts. Some items are a full days worth of calories and multiple days worth of saturated fat. If people stopped eating there that would probably solve the healthcare crisis (kidding).

Agreed!

We work pretty hard to eat healthy AND tasty.....I have only ever been inside a Cheesecake Factory once in the late 90's.

I would be keen to see their frontline operational process management....sounds pretty cool.

An old friend from high school is GM of a Cheesecake Factory operation in Florida.......I might have to try to fit it into my schedule to swing by......I try to put a bit of effort into personal health/fitness....maybe I can justify a piece of cheesecake for research purposes!

[c1ue]

Re: More fun with for-profit medicine

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?

Why let us pocket the savings, when they can?

[Ghent12]

Re: More fun with for-profit medicine

So a drug that was recently approved by the FDA (with all of its fees, delays, and other interferences) went through the complicated hospital pricing structure system and came out as very, very expensive; and you want to blame for-profit institutions or the concept of free markets for this?

A simple search reveals a more complete picture, rather than the puerile "USA system bad, free markets bad because price bad" rhetoric. I originally was quite thrilled by this forum and its members' apparent attention to minutia and tracing out the actual origins of the matters being discussed. I didn't imagine that the site was simply an echo chamber for a few members who built up a reputation which was beyond basic fact checking.

It was great news when a scorpion antivenom was finally approved for use in the United States.Then, we saw the price. Hospitals are charging as much as $12,467 a vial for Anascorp.
With treatment requiring three to five doses, the bill to patients and their insurance companies can top $62,000, Arizona Republic reporter Ken Alltucker found.

After clinical trials, where Anascorp was available for free, cost is suddenly a hurdle. Especially in a state where 1.3 million people are on AHCCCS, putting taxpayers on the hook, and 1.2 million have no insurance coverage at all.
This is the same drug that has been used for years in Mexico, where it costs $100 or less. What's going on here?
It starts with the time and expense of getting drugs approved by the U.S. Food and Drug Adminstration. Going through all the hoops to ensure Anascorp's effectiveness, safety and quality took 12 years. We don't want shortcuts there.
But two other factors are driving prices into the stratosphere, and they both need changing: the challenge of an "orphan drug" and the convoluted dynamics of hospital pricing.
Orphan drugs are those that treat rare conditions in which the potential market is too small to interest big pharmaceutical companies. Bark scorpions, with their life-threatening stings, are found almost exclusively in Arizona.
So, virtually all the expenses of developing Anascorp are spread over Arizona patients, a tiny group compared with the mass market for a mainstream drug. That math may be inevitable.
The FDA fee structure isn't. To help finance its operations, the agency charges annual fees on prescription drugs.
Orphan drugs are exempt, but only if the manufacturer has overall companywide sales of less than $50 million. Rare Disease Therapeutics, which shares U.S. rights to the drug with Instituto Bioclon, hasn't reached that threshold. But, anticipating that it will, the company has included the annual fees in its price structure.
The FDA formula defies logic: The exemption should be based on sales of the orphan drug itself.
Hospital markups are the other driving force in the cost of Anascorp. Rare Disease Therapeutics sells the drug for $3,500 to a distributor, which then charges hospitals $3,780.
Hospitals then set a vastly higher price, assuming that insurers will pay just a fraction of it and that many patients won't pay the full amount. Insurers, for their part, are still figuring out whether they'll limit coverage to children and the elderly, who are most at risk of potentially fatal reactions.
Will patients be priced out of Anascorp? It's hard to imagine -- and outrageous even to consider -- that cost would stand in the way of treating an infant.
But the "walking miserable," the adults who will miss work and suffer the neurological havoc of the venom, may well be out of luck.
Anascorp could be the start of a string of drugs to treat conditions that hit Arizona particularly hard, including valley fever and black-widow spider bites.
And the cost question threatens to cloud their promise, too.


Read more: http://www.azcentral.com/arizonarepu...#ixzz26C99XtiX

Gee, imagine that! A government fee structure is set up in a way that sounds logical only prima facia, yet has the result of tending to be asinine in practice.

Well the FDA and its pernicious influence accounts for one and a half order of magnitude in the price increase; what about the other half order of magnitude? Why did the hospital charge so much more than it paid for the drug? The first step in that is covered by the article I quoted. Why does the system exist the way it does? Because of the insurance companies. Now that is a subject for multiple other threads, but if you think health insurance companies operate under unfettered free market principles, then I've got an unpressurized airliner ticket to sell you.

[cmalbatros]

Re: More fun with for-profit medicine

http://www.youtube.com/watch?v=dRn9ySc-RDM

[flintlock]

Re: More fun with for-profit medicine

Regardless of who is at fault( I'm sure there is lots of blame to go around), eventually all these knuckleheads will find themselves being paid a fixed price mandated by law if they don't get their act together. With the resulting shortages and poor care. They are going to kill the goose that laid the Golden Egg, and everyone involved will suffer for it.

[flintlock]

Re: More fun with for-profit medicine

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.)

Yes, I arrived at the same conclusion. Its the reason in Atlanta, ambulance emergency rates are fixed by the State. Can you imagine the bills otherwise? ( Still over $1000 trip now) I find most die hard free market zealots in regards to Healthcare have never had to use it very much. Its when its your butt on that table, having to put a price on your own health, that it really sinks in. Or rather, when you realize someone else has more say in the matter than you do.

[flintlock]

Re: More fun with for-profit medicine

The more I think about this subject, the more I thing the lack of upfront pricing is the root of the problem. Its not only that people could shop around, but that any gouging would quickly become public information, and those responsible would feel the wrath of the press and public. Imagine going to a restaurant and being charged $2000 for a steak. Word would get out quickly and they'd be out of business almost overnight. Who wouldn't love to run a business where you just charge whatever you feel you can get away with, and threaten to ruin people's credit if they don't pay. Perhaps its time at least Emergency procedures should have some limits placed on them. I don't know.

[flintlock]

Re: More fun with for-profit medicine

So a drug that was recently approved by the FDA (with all of its fees, delays, and other interferences) went through the complicated hospital pricing structure system and came out as very, very expensive; and you want to blame for-profit institutions or the concept of free markets for this?

A simple search reveals a more complete picture, rather than the puerile "USA system bad, free markets bad because price bad" rhetoric. I originally was quite thrilled by this forum and its members' apparent attention to minutia and tracing out the actual origins of the matters being discussed. I didn't imagine that the site was simply an echo chamber for a few members who built up a reputation which was beyond basic fact checking.



Gee, imagine that! A government fee structure is set up in a way that sounds logical only prima facia, yet has the result of tending to be asinine in practice.

Well the FDA and its pernicious influence accounts for one and a half order of magnitude in the price increase; what about the other half order of magnitude? Why did the hospital charge so much more than it paid for the drug? The first step in that is covered by the article I quoted. Why does the system exist the way it does? Because of the insurance companies. Now that is a subject for multiple other threads, but if you think health insurance companies operate under unfettered free market principles, then I've got an unpressurized airliner ticket to sell you.

I was going to bring up the FDA also until I read a little more. We go from $100 in Mexico, through a few people, and we are at $3780 by the time the distributor sells it. What gets us to the hospital's $37,000? The FDA hurdle is already past. Interim profits have been taken. No, I think there are a lot of red herrings being thrown around by hospitals to justify taking advantage of people in a bind.

I still am not clear why hospitals and Physicians feel the need to overcharge and then settle on a lower fee with insurance. I can understand minor differences. Makes me suspect accounting tricks and ability to write off phantom charges as bad debts.

Insurance by its nature is not really free enterprise. A corporate Oligarchy at best. A Cartel might be more like it. Most working people get insurance through an employer. How many have unfettered choice in that matter? The sooner health insurance is taken completely out of the realm of employment, the better.

[Ghent12]

Re: More fun with for-profit medicine

Regardless of who is at fault( I'm sure there is lots of blame to go around), eventually all these knuckleheads will find themselves being paid a fixed price mandated by law if they don't get their act together. With the resulting shortages and poor care. They are going to kill the goose that laid the Golden Egg, and everyone involved will suffer for it.

Are they? The medical insurance industry is extraordinarily powerful. They have already gotten mandated health insurance passed. Obamacare is "public-private partnership" incarnate. This is how the world actually works--industries capture government, and government acquiesces. Maybe we should start looking at all of the government efforts to prop up given industries, such as tax-exempt health insurance compensation, with the suspicion they have deserved all along.

[Ghent12]

Re: More fun with for-profit medicine

Yes, I arrived at the same conclusion. Its the reason in Atlanta, ambulance emergency rates are fixed by the State. Can you imagine the bills otherwise? ( Still over $1000 trip now) I find most die hard free market zealots in regards to Healthcare have never had to use it very much. Its when its your butt on that table, having to put a price on your own health, that it really sinks in. Or rather, when you realize someone else has more say in the matter than you do.

People already have more say in the matter than you do, especially if you require an ambulance. This doesn't change whether the marketplace is allowed to allocate resources where they are most demanded or whether government has control.

[DSpencer]

Re: More fun with for-profit medicine

I was going to bring up the FDA also until I read a little more. We go from $100 in Mexico, through a few people, and we are at $3780 by the time the distributor sells it. What gets us to the hospital's $37,000? The FDA hurdle is already past. Interim profits have been taken. No, I think there are a lot of red herrings being thrown around by hospitals to justify taking advantage of people in a bind.

Partly it's because the hospital is including many costs it can't charge for into the cost of the drug. They can't bill for the building, utilities, lawsuits, the costs of other patients who receive free care, etc so all that is wrapped up under other charges. Do the hospitals in Mexico charge $100 or is that the manufacturer's price? How much does a nurse make in Mexico?

But mostly because it's a game. As I said earlier in the thread: " 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."

This is as much as I could find:

http://abcnews.go.com/Health/arizona...5#.UFCVmVFIV0Q

Chandler Regional Medical Center released a statement apologizing for Edmond's treatment costs, explaining that they are working to adjust the high "out-of-network" bill she received for the anti-venom.
"In addition, we are also currently reviewing our pricing of this expensive specialty medication," the statement said.

Adjust meaning reduce, so it sounds like she won't pay the full bill. It's still unclear what, if anything, she will pay.

I still am not clear why hospitals and Physicians feel the need to overcharge and then settle on a lower fee with insurance. I can understand minor differences. Makes me suspect accounting tricks and ability to write off phantom charges as bad debts.

Insurance companies often have a maximum "allowable amount" based on a variety of different formulas depending on the policy. They then work from the lower of the charged amount or the allowable amount and subtract deductibles, co-insurance, co-pays in order to determine how much they will pay. So basically the hospital is trying to ensure that they are charging enough to obtain the full payment from the ins co. Then they can determine whether they want to balance bill the patient for the amount that's not covered. In this case it seems they balanced billed the patient for the whole amount. Then they agreed later to adjust the amount. We'll never know what they would have done without the news article. It could be an attempt at price discrimination: Send a bill and if the person's wealthy they might just pay. If they complain, then you can negotiate.

Just as I wouldn't go into a car dealership and offer full price, I wouldn't pay a gigantic emergency services bill without at least asking for a reduction.

If there's some accounting angle, I don't know what it is or how it would work.

Insurance by its nature is not really free enterprise. A corporate Oligarchy at best. A Cartel might be more like it. Most working people get insurance through an employer. How many have unfettered choice in that matter? The sooner health insurance is taken completely out of the realm of employment, the better.

We don't have a free market in the US in healthcare. We have a complete mess. People who want single payer pretend that we have a free market so they have a straw man to attack.

Your last sentence is dead on.