“You call up doctors and ask the price…”

[moneymaker]

Yes I like the idea of a HSA, currently have a flexible spending account where I have to guess how much I will be needing a year in advance and if I’m wrong can only carry over $500 to the next year. I really should get a doctor for yearly checkups but I’m afraid they might find something like stage 4 lung cancer like in the movie Dead Pool (dad smoked a lot when I was young). Anybody recommend a reasonably priced but excellent doctor?

[Anonymous]

[quote=moneymaker]Yes I like the idea of a HSA, currently have a flexible spending account where I have to guess how much I will be needing a year in advance and if I’m wrong can only carry over $500 to the next year. I really should get a doctor for yearly checkups but I’m afraid they might find something like stage 4 lung cancer like in the movie Dead Pool (dad smoked a lot when I was young). Anybody recommend a reasonably priced but excellent doctor?[/quote]

If it turns out you had stage 4 lung cancer the cost of the first doctor you visit will be insignificant in the big picture. And it won’t be so easy to negotiate chemotherapy, MRIs, and the hundreds of other charges that you will receive on your invoice once treatment starts.

‘Self insuring” works for things that have limits to their costs. It’s reasonable and wise to self insure the warranty on your TV, or even against a car being totaled in an accident.

But self-insuring for catastrophic losses is not insuring at all. Some will win the roll of the dice and say their plan “worked” but the evidence provided by these anecdotes are easily countered by those who weren’t lucky. A national healthcare program that does not allow everyone to participate in a risk pool is not a healthcare program.

Trump promised “insurance for everybody.” Of course like so many claims he’s made he didn’t really understand what he meant, has no real plan to make it happen, and his supporters won’t hold him accountable to it.

Here’s to good health for everyone! – because best wishes and hope are the only insurance many will have.

[FlyerInHi]

Trump said his terrific health plan will be out by end of March at the latest.

It’s really shameful that a rich country like the USA doesn’t have universal simple health care for its citizens.

Do working and middle-class Americans really not understand what they don’t have compared to other citizens of the developed world, and even the developing world?

[kev374]

I got a checkup when I was in Bangalore, India a few months ago. State of the art hospital using the same million dollar machines (from GE, Seimens whatever) used in American hospitals. I paid $50 out of pocket for Ultrasound, Full bevy of comprehensive tests including Lipid profile, Pre/Post glucose, stress test, consult with nutritionist, Dental consult, consult with Doctor, EKG, X-Ray, Bone density test and more. Not only that they gave me a full folder containing all the results, images and plots in addition to a CD with all the test data.

Oh, not to mention a delicious breakfast was also included on the house. Somehow the economics work for this hospital that has also bought these same machines for millions of dollars.

The same tests in the US would’ve cost me $10,000 or 200 times more. I can understand 3X-4X the cost but 200X? I want to know why.

Healthcare in the US is nothing more than a money making racket.

I’ve said it before and I will say it again… no healthcare strategy will EVER WORK unless we get to the bottom of why costs are so ridiculously astronomical compared to everything else in our economy. We have to get costs to a more reasonable level or we are just going to go in circles without solving anything.

[Anonymous]

[quote=kev374]I’ve said it before and I will say it again… no healthcare strategy will EVER WORK unless we get to the bottom of why costs are so ridiculously astronomical compared to everything else in our economy. We have to get costs to a more reasonable level or we are just going to go in circles without solving anything.[/quote]

The cost will vary greatly in the US depending upon who is paying. When Medicare pays costs are much lower – even “reasonable” – because the government has negotiating power. Insurance companies have similar leverage. Individuals might be able to shop around for simple stuff but they don’t stand a chance when it comes to the big ticket items that constitute the majority of healthcare costs.

Single payer would bring costs down. “Everyone for themselves” will not.

One of the Republican memes in the healthcare debate is “tort-reform.” It’s a red herring intended to make the public believe that costs are astronomical because of malpractice lawsuits. There’s no data whatsoever to support their argument, but when did facts matter?

[FlyerInHi]

John Oliver explained it pretty well.

[no_such_reality]

[quote=kev374]I got a checkup when I was in Bangalore, India a few months ago. State of the art hospital using the same million dollar machines (from GE, Seimens whatever) used in American hospitals. I paid $50 out of pocket for Ultrasound, Full bevy of comprehensive tests including Lipid profile, Pre/Post glucose, stress test, consult with nutritionist, Dental consult, consult with Doctor, EKG, X-Ray, Bone density test and more. Not only that they gave me a full folder containing all the results, images and plots in addition to a CD with all the test data.

Oh, not to mention a delicious breakfast was also included on the house. Somehow the economics work for this hospital that has also bought these same machines for millions of dollars.

The same tests in the US would’ve cost me $10,000 or 200 times more. I can understand 3X-4X the cost but 200X? I want to know why.

Healthcare in the US is nothing more than a money making racket.

I’ve said it before and I will say it again… no healthcare strategy will EVER WORK unless we get to the bottom of why costs are so ridiculously astronomical compared to everything else in our economy. We have to get costs to a more reasonable level or we are just going to go in circles without solving anything.[/quote]

Actually, nothing you listed is a million dollar machine (or tens of million dollar machines like proton therapy). Everything you listed is a pretty run of mill test using pretty reasonable equipment.

Comparatively, $50 is actually, quite a lot with $8000 putting you on the top of middle income and the Doctors serving you made around $12000.

It doesn’t explain the vast differences those boil down to a real simple problem. Somebody else is paying for it. American’s treat their insurance almost like an all you can eat buffet. You paid the entrance cost with your insurance now you just pile everything on your plate.

We’ve also created layers and layers of additional costs in administrative functions playing whackamolevtrying to get paid.

[Anonymous]

[quote=no_such_reality]American’s treat their insurance almost like an all you can eat buffet. You paid the entrance cost with your insurance now you just pile everything on your plate.[/quote]

That is complete nonsense.

Insurance companies and medicare – the entities that control almost all of the spending in American healthcare – do not allow people to “just pile everything on their plate.”

Procedures that aren’t approved don’t happen. Bean counters at the insurance companies control the approvals.

This is Exhibit A of why the Republicans can get away with such absurd arguments in the healthcare debate. So many Americans believe in some alternate reality.

Watch the John Oliver piece linked above. It nails the crux of the issue and explains clearly why ACA at least addresses the key points. The “repeal and replace” crowd cannot even define the problem, let alone offer a solution.

“Take your $3000 tax credit and shop around for a heart surgeon.”

Problem solved!

[no_such_reality]

I see your reading comprehension hasn’t improved.

Again, the nut of the problem is somebody else is paying for it. Yes, the consumer is still paying for it, just four layers removed in a business with no prices published.

Again, it’s like a buffet in that they don’t have to think about what it is they’re getting. They don’t have to think about the price. They don’t have to think…

That’s the nut of the problem.

What’s the chief complaint people have? The part they actually have to pay for. Gnash teeth, the copay has gone up, OMG, the doctors are actually collecting co-pays.

It’s a broken system where the providers provide a service with no concern over the consumers actual ability to pay for it. What part do Doctors hate the most? The fact that they actually have to manage collecting co-pays now or the price sharing wrecks their income model.

Yea, so it’s a buffett where the casino boss is telling you don’t need the lobster…

[Anonymous]

[quote=no_such_reality]Again, the nut of the problem is somebody else is paying for it. Yes, the consumer is still paying for it, just four layers removed in a business with no prices published.[/quote]

Four layers? You’re just making up numbers.

[quote]Again, it’s like a buffet in that they don’t have to think about what it is they’re getting. They don’t have to think about the price. They don’t have to think…[/quote]

The people writing the checks to healthcare providers very much think about the price. There is an entire industry committed to managing healthcare costs. “They” think about it as a full time profession.

[quote]It’s a broken system where the providers provide a service with no concern over the consumers actual ability to pay for it.[/quote]

Completely false. Patients with insurance get very different care than those who do not have insurance. Wealthy patients who can prove their ability to pay get very different care than those who have no money. These facts are not even remotely debatable.

Emergency care providers are required by law and ethics to stabilize patients who are in a life-threatening situation. That is the only time that cost is ignored. And once patients are stable, if you don’t have the money you leave the hospital.

Providers do not simply hand out healthcare with no concern for costs. Need an expensive procedure like an MRI? The doctor will have to justify the cost to the insurance company. They don’t simply say “hey, it’s all you can eat – let’s run every procedure.”

Are you actually claiming that cardiologists just perform triple bypass surgery on anyone who walks into the office who needs it, without asking how they are going to pay?

If you don’t have insurance – i.e. “the actual ability to pay” you won’t get the care.

Before ACA, there were millions of Americans in that very situation. Today there are fewer but nobody is just handing out healthcare without any concern for cost.

[quote]Yea, so it’s a buffett where the casino boss is telling you don’t need the lobster…[/quote]

Your nonsensical analogies don’t hide that you have no clue how healthcare in America works.

[FlyerInHi]

So Obamacare repeal would most benefit middle to upper class, young, healthy individuals. The older sick, working class guys will get screwed because they won’t be able to afford health care, even with the tax credits. Sounds like Trump voters will get the hopey changey they clamored for.

https://www.washingtonpost.com/blogs/plum-line/wp/2017/03/02/republicans-already-think-obamacare-repeal-is-a-nightmare-its-about-to-get-worse/?hpid=hp_no-name_opinion-card-c%3Ahomepage%2Fstory&utm_term=.d5ec3cf8f219

[no_such_reality]

[quote=FlyerInHi]So Obamacare repeal would most benefit middle to upper class, young, healthy individuals. The older sick, working class guys will get screwed because they won’t be able to afford health care, even with the tax credits. Sounds like Trump voters will get the hopey changey they clamored for.

https://www.washingtonpost.com/blogs/plum-line/wp/2017/03/02/republicans-already-think-obamacare-repeal-is-a-nightmare-its-about-to-get-worse/?hpid=hp_no-name_opinion-card-c%3Ahomepage%2Fstory&utm_term=.d5ec3cf8f219%5B/quote%5D

The math is really simple. It’s 7th grade algebra.

We’ve got two groups of people, basically healthy and those with chronic conditions. At present 45% of the adult population has a chronic condition (aside from just being fat).

Insurance is a the simple part. You take the amount they pay for services, you add a bunch of administrative costs at the provider for dealing with insurances, you add couple boatloads of inefficiency and admin costs at the insurance carrier and then you add profit. We’ll call that Z, of in the case of a single insurance company we can call it $184 Billion.

Now, the simple math.

0.55X+0.45Y=$184 Billion.

And if you want X to be lower then Y needs to be even higher.

Or you bend the cost curve.

Seems pretty obvious were to cut inefficiencies to me.

[Anonymous]

[quote=no_such_reality]Seems pretty obvious were to cut inefficiencies to me.[/quote]

That last sentence perfectly illustrates the quality of your argument.

[FlyerInHi]

NSR, real quick here before I go back to home remodeling.
Your equation lacks the total amount of services. You focus on profit while aggregate health spending/revenue is much more important. Trump wants more services to cover everyone for less total spending. Let’s see how he solves the equation. He won’t.

[no_such_reality]

[quote=FlyerInHi]NSR, real quick here before I go back to home remodeling.
Your equation lacks the total amount of services. You focus on profit while aggregate health spending/revenue is much more important. Trump wants more services to cover everyone for less total spending. Let’s see how he solves the equation. He won’t.[/quote]

He won’t. Essentially, single payer is how to bend the cost curve, but that’s anathema to the GOP. I’m not emphasizing profit, I see it as an excess and questionable if necessary, cost. The main benefit of those profits is the innovation in services and treatments.

You bend the cost curve (in aggregate) in three simple ways:

A) You reduce the overhead (insurance companies, their required administrative burden and their profits).

B) You reduce the cost of services (either by reducing the cost of providing service or by limiting access to higher cost services [i.e. proton therapy]), or implementing price controls such that companies like Mylan can’t game the pricing market.

C) You reduce the demand for services.

“The People” are really clear, they don’t have an tolerance for C if it impacts them. Nor B, if it means they have to wait or can’t get their desired option. And if you really want to piss them off, tell them the cost benefit of treatment 2 doesn’t warrant the extra cost over treatment 1, that the specialist has told them is sooooo much better.

Which really just leaves A. And if you refuse to do “A” then the only option you really have to play a shell game of shuffling costs so that 60-80% are less impacted and the remainder is just short of porked.

Again, the math is really simple. If your family (and a bunch of others like it) uses on average X dollars of services, insurance (in aggregate) has to charge your family $X + administrative overhead + profit.

Or make the Doctors charge less (and make less), make the drug companies charge less, etc.

It’s a lot like the budget, after years of reduction in the deficit, we still have a deficit that is over 40% of the discretionary budget. Not counting defense spending which our President said he wants to increase spending on, it accounts for about 80% of the non-defense budget.

We want our cake, we want to eat it too, and we don’t want to pay the bill.

[Author]

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