More fun with for-profit medicine

[lektrode]

Re: More fun with for-profit medicine

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.

any comment/idea on how we will avoid 'single payer' ?

or my concept of a 6th branch of the .mil that could be called the medical corps, that would provide an option (and some competition to the med/ins/drug-industrial complex) and act as provider of last resort to those who simply have NO other option, than to goto the nearest emergency room? (and let bankruptcy do its thing)

[DSpencer]

Re: More fun with for-profit medicine

any comment/idea on how we will avoid 'single payer' ?

Maybe by entrenched corporate interests controlling the legislative process and continuing to leave us trapped in a worst of both worlds scenario.
Maybe we won't avoid it.
Otherwise a miracle.

or my concept of a 6th branch of the .mil that could be called the medical corps, that would provide an option (and some competition to the med/ins/drug-industrial complex) and act as provider of last resort to those who simply have NO other option, than to goto the nearest emergency room? (and let bankruptcy do its thing)

Not sure why it would be part of the military. Would this service provide expensive treatments to extend lives by 3 months or provide more basic life saving treatments? I think you might underestimate the amount of money required for this.

[flintlock]

Re: More fun with for-profit medicine

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.

Agree completely. But at the current rate of rising costs, the insurance companies will find less people paying them and more and more instead dependent on government programs for healthcare. They will ultimately be cut out of the loop. Its a Blood from turnip situation. I think some form of Socialized medicine is coming if nothing changes. The Insurance industry's best bet would be to position themselves as the administers for Socialized medicine when it comes. Something I'd prefer to a government administration. Current system money flow of Patient>Insurance>Provider will become Taxpayer> gov>patient. My guess is insurance companies will slip themselves into that gap between GOV and Patient, or Taxpayer>GOV>former insurance companies> provider. After all, they already have systems in place to administer the payments. But instead govt will be setting prices, with all that entails, both good and bad. " Good news is your operation will only cost $200. Bad news is the six month wait".

[flintlock]

Re: More fun with for-profit medicine

I still don't understand why my doctor bills my insurance more than he will accept. He already knows my insurance company. I think its a game of fishing for the highest price possible. Like the car dealer analogy, they always ask retail and then work off that. But then I suppose he has that right like any other business.

[wayiwalk]

Re: More fun with for-profit medicine

I see the toughest part of setting up front prices sort of the challenging in engineering projects that involve specs/plans that go out to bid. In work with sites surrounded by existing structures/infrastructure, there's almost always the unanticipated situation that was not shown on plans or specs, results in a change and a claim from the contractor doing the work to be paid more for addressing the changed conditions. As we often note - you never know what you're really going to find until you start digging....

Certainly this must come up in surgical procedures often.....where the patients body is not in the good health they thought, the doctors find something else during the procedure that they must address.

When you go with "lump sum" or "fixed price" bid for work - you always end up paying more since contractors will pad their bids to account for variantions from what they expected to encounter during the work. I thnk you'd see similar pricing for medical procedures if they had to quote everything up front.

[wayiwalk]

Re: More fun with for-profit medicine

Agree completely. But at the current rate of rising costs, the insurance companies will find less people paying them and more and more instead dependent on government programs for healthcare. They will ultimately be cut out of the loop. Its a Blood from turnip situation. I think some form of Socialized medicine is coming if nothing changes. The Insurance industry's best bet would be to position themselves as the administers for Socialized medicine when it comes. Something I'd prefer to a government administration. Current system money flow of Patient>Insurance>Provider will become Taxpayer> gov>patient. My guess is insurance companies will slip themselves into that gap between GOV and Patient, or Taxpayer>GOV>former insurance companies> provider. After all, they already have systems in place to administer the payments. But instead govt will be setting prices, with all that entails, both good and bad. " Good news is your operation will only cost $200. Bad news is the six month wait".

Given how effective the insurance companies fared with the Affordable Care Act (more patients = more money, by virtue of the law), I think they'll manage to come out ahead of whichever way this goes.

[wayiwalk]

Re: More fun with for-profit medicine

I recently had a discussion with a doctor friend of mine, he talked about another upcoming wrinkle with healthcare in this country which is the training of doctors.

In his generation (we're in our late 40's), the doctors in resident programs put in insane, mega hours, I don't have numbers, but I recall back then that 100+ hr weeks weren't unusual.

That has changed apparently - hours in many (all?) programs are cut way back, and the current batch of doctors coming off residency don't have the same degree of knowledge/training/experience when they are officially ready to practice.

He told me that his practice recently had to pass on inviting a new grad to join their practice, the fellow just wasn't ready and wasn't good....and, I guess their business model doesn't include training someone.

He also noted that this year marked the first time that the number of doctors employed by others (ie hospitals), exceeded those who work in their own practice (or one that they are a partner in).

The current generation is also looking for the work-life balance (aren't we all?) and prefer to check out at 5 (or whenever their shift ends, he says there is even a term for the doctors who specialize in night shifts, I wish I could recall what it is).

That may have the impact of driving down prices (ie, the doctors are no longer negotiating or as someone said above, playing chicken, with the insurers.....but it also seems apparent that it will push down quality of care as well.

This one is a moving target!

[Ghent12]

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.

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.

It's all about incentives, flintlock. As I said, the second part of the cost increase, the half order of magnitude increase, comes from the Byzantine hospital pricing system which is the result of a very long process developed in response to the incentives facing all the participants involved. The system as it exists, which is a far cry from any pure ideological system, creates the incentives for hospitals to behave the way they behave and for insurance companies to behave the way they behave.

You are absolutely right in spirit that health insurance should be taken out of the realm of employment, but not quite correct in substance. The ideal solution would be to have never passed tax-exempt status for health insurance as compensation for employment, but there should also not be a ban on providing health insurance as compensation if a company and an employee so choose to mutually agree on that. But those in the health insurance industry have been chosen by the government as winners for decades now due to the health insurance tax exempt status. The government chose the winners, and those winners are still benefiting now because of that status, which still largely exists.

What's the way forward? To give the right incentives to be efficient. Right now there are few because "someone else" is always paying. There may be no way to reduce the costs below a certain point, however--a lot of old farts need a lot of care, and the only way to provide that care is to allow for the incentives for people to provide it, which means a tendency for a higher price. Yet ever-increasing demand need not necessitate ever-increasing price. The key, then, would be to reduce constraints upon supply, which yes, that means not having it take 12 years to complete the FDA review process for a single damn drug, among other quite obvious reforms.

[shiny!]

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.

Imagine taking your car to the shop for a repair, or having a repair done on your house without getting an itemized quote up front. Then getting the bill months later for whatever they decide to bill you and having no recourse but begging to wheedle down the bill. It's "Pay it or else."

Imagine, as was mentioned earlier, buying a car but the dealer refusing to give you a price. Taking said car home and receiving a bill months later for whatever they please. Again, you're left begging and wheedling to get the price down. In addition, the price only covers part of the car, not the entire car. Your insurance has to pay for other parts of the car, and your employer (if you have one) pays for portions of your insurance. The price you pay for the car will vary depending on how each of these parties manages to wriggle out of paying.

It's outrageous that we must put up with this for our healthcare.

That said, I still don't want government managed health care because it will be staffed and run by professional bureaucrats and mouthbreathers of the caliber that run the DMV and the Dog Pound.

I want to pay my providers directly without middlemen sticking their noses into my business. I want insurance for catastrophic illness or injury only, and I want it to be as simple as possible. I want to buy this insurance privately, the way I buy my home and car insurance, and I want competition and full transparency to make it affordable.

Fat chance of me getting what I want.

[LazyBoy]

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.

Upfront pricing with the same price for everyone. Health insurance companies can go back to spreading risk, not negotiating pricing. Or they can go away altogether.

The Insurance industry's best bet would be to position themselves as the administers for Socialized medicine when it comes. Something I'd prefer to a government administration.
...
After all, they already have systems in place to administer the payments. But instead govt will be setting prices, with all that entails, both good and bad. " Good news is your operation will only cost $200. Bad news is the six month wait".

I know the "six month wait" problem happens in some single payer countries. But I'm not convinced that an additional layer of profit-seeking administration is needed to fix that or even necessarily will fix that.

The insurance industry takes too large a cut. Look at their profits.

[flintlock]

Re: More fun with for-profit medicine

I recently had a discussion with a doctor friend of mine, he talked about another upcoming wrinkle with healthcare in this country which is the training of doctors.

In his generation (we're in our late 40's), the doctors in resident programs put in insane, mega hours, I don't have numbers, but I recall back then that 100+ hr weeks weren't unusual.

That has changed apparently - hours in many (all?) programs are cut way back, and the current batch of doctors coming off residency don't have the same degree of knowledge/training/experience when they are officially ready to practice.

He told me that his practice recently had to pass on inviting a new grad to join their practice, the fellow just wasn't ready and wasn't good....and, I guess their business model doesn't include training someone.

He also noted that this year marked the first time that the number of doctors employed by others (ie hospitals), exceeded those who work in their own practice (or one that they are a partner in).

The current generation is also looking for the work-life balance (aren't we all?) and prefer to check out at 5 (or whenever their shift ends, he says there is even a term for the doctors who specialize in night shifts, I wish I could recall what it is).

That may have the impact of driving down prices (ie, the doctors are no longer negotiating or as someone said above, playing chicken, with the insurers.....but it also seems apparent that it will push down quality of care as well.

This one is a moving target!

My doctor said basically the same thing. That he feels he is very well paid, (works for a clinic), doesn't really like the business end of things, and had rather have some balance in his life than a bigger house or nicer car. He also thinks socialized medicine of some sort is around the corner.

[flintlock]

Re: More fun with for-profit medicine

Upfront pricing with the same price for everyone. Health insurance companies can go back to spreading risk, not negotiating pricing. Or they can go away altogether.



I know the "six month wait" problem happens in some single payer countries. But I'm not convinced that an additional layer of profit-seeking administration is needed to fix that or even necessarily will fix that.

The insurance industry takes too large a cut. Look at their profits.

I am inclined to agree. The key is to continue make medicine lucrative enough to attract talent.

[vinoveri]

Re: More fun with for-profit medicine

Anecote as to how Dr.s' and Medical Practice deal with low reimbursenement from insurance Co.:

Have BCBS insurance with pretty good benefits
As a result of an accident was admitted to an in-network hospital and was treated by attending physician.
All services paid by BCBS as in-network except for attending physician who billed me $1650 (he was good but literaly saw me personally twice for a total of 15 minutes)
BCBS paid the Dr's practice $400 and he sent me a bill for $1250. When I pointed out to his office and BCBS that he is listed as an in-network provider on BCBS own website, was informed that the Dr. uses multiple "tax-id" numbers and submitted the bill under a different provider number so BCBS treated it as out-of-network and I'm responsible for the rest. When I asked the Dr.'s office to resubmit under the in-network #, was told that they don't participate in-network for "trauma" cases.

Warning to watch out for this scam (obviously Dr.'s practice doesn't think he's reimbursed enough for the services - fair enough - but I'm very good about insuring the treatment I receive is in-network, but this is difficult to insure under "Trauma" conditions; ie. you can't choose who is attending in the ER) - This is a HealthFirst company by the way

[LorenS]

Re: More fun with for-profit medicine

... 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.

I tend to agree, however, this "benefit" is the one and only thing that gives an employer any reason to have some kind of interest in the health of the employees. Not that they really care much, but without this thread of accountability they would care even less. Most occupational hazards in the modern workforce don't show up in worker's comp claims. Ulcers, clogged arteries etc are not directly attributed to stress and 12 hour work days.

My company got rid of my partner (and a bunch of other experts who used to collaborate with me) in the meantime the stress level has gone up exponentially. I've put on 10 lbs, don't sleep as well and have less time with my family. At the same time I'm getting company "advice" on how to live healthy - exercise, lose weight, get enough sleep. Ha, ha.

Modern corporate management has no concept of the life lived by their rank and file. They get enough $$ in one quarter to live like kings for the rest of their life, there's no incentive to plan for a decade of profitable enterprise. It's all about next quarter. The employees, however, need a paycheck until death.

It's not just for profit organizations that are run this way either. In nearly every organization the incentive structure for the top 5 employees is diametrically opposed to the interests of the other stakeholders be they share holders, employees or contributors.

Many industries/services are suffering the same catastrophic failures being seen in health care.

[seobook]

Re: More fun with for-profit medicine

I work on the web from home & so do all of our employees. I think not having to deal with rush hour traffic is a huge huge win on the stress front.

I sent some of the people who work for us a fitbit pedometer, in part because when I have one I can push myself to ensure I take time out to exercise each day & that makes me less gloomy + more creative. Somehow the arbitrary number on the pedometer screen is a form of accountability, even though it doesn't have a direct consequence.

I also got one for my mom too ... I might be a bit of an eccentric walking 10k steps a day though, but it is no more crazy than sitting at a computer for 16 hours and getting no exercise at all. I figure if any of our workers use it they will be happier and more productive and that sort of an upgrade in life quality for such a low cost is a huge win

I spent years (say 8 of the last 10) working too hard & destroying my physical health by soaking in work & stress. But recently after hosing a knee a few months back (I couldn't straighten my leg until after seeing a doctor ... they jerked my leg in a number of directions & in doing so somehow cleared blockage in it & I think they fixed whatever was wrong without even realizing quite how bad/hosed it was) I decided that path wasn't worth it. I don't have health insurance & my mother in law is a nurse. She told us where to go & the cost for seeing that doctor & paying cash was only a hair over $100 (in California no less). I bet if I had insurance the payment I would have had to make in addition to insurance would have been much higher than the $100 I spent.

It is really hard to justify destroying your health to make more money when some of that money will lose most of its value before you have a chance to spend it. Taking an hour each day to walk or do other similar low impact stuff has huge benefits. It is like getting most the benefits of an insurance program (and even many benefits that are not included in insurance) without the cost ;)

We (my wife and I) used to have health insurance but dropped it a few years ago as it seemed a bit nuts it being over a grand a month. Since then we have spent just over $100 & are about $30,000 ahead for not having insurance (maybe $40,000 given inflation). Anything short of a major organ failure & we will have saved enough to pay for it in cash within 5 years of not having insurance. And that savings also lowers stress levels. Of course soon we will be required to carry insurance, but I will likely be in better shape by the time we do & will opt for a ridiculously high $50,000 deductible or some such in order to make the insurance cost as low as possible.