Citizens with Citizens with emergencies…yes. Illegals…no.
NotCranky
January 14, 2011 @
1:05 PM
Only people who have served Only people who have served in the military or agree to serve in the military in the future illegal or not.
EmilyHicks
January 14, 2011 @
1:09 PM
What make them so special? What make them so special? Most people enter the military only because they can’t find good jobs.
[quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
NotCranky
January 14, 2011 @
1:18 PM
EmilyHicks wrote:What make [quote=EmilyHicks]What make them so special? Most people enter the military only because they can’t find good jobs.
[quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote][/quote]
Yes, what makes people who can’t find good jobs with health care special?
scaredyclassic
January 14, 2011 @
1:43 PM
Yes. Yes.
patb
January 15, 2011 @
8:02 PM
Rustico wrote:Only people who [quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
If you want to honor the Armed Uniformed Services,
will you include the Post Office?
ocrenter
January 16, 2011 @
6:24 AM
patb wrote:Rustico wrote:Only [quote=patb][quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
If you want to honor the Armed Uniformed Services,
will you include the Post Office?[/quote]
well, some of them certainly are armed…
NotCranky
January 16, 2011 @
8:51 AM
ocrenter wrote:patb [quote=ocrenter][quote=patb][quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
If you want to honor the Armed Uniformed Services,
will you include the Post Office?[/quote]
well, some of them certainly are armed…[/quote]
I am a veteran and sometimes I go postal, damn right we should all have health care, civilians too, any of them. Treat illegals, and then kick them out if you have to, prove to me mr. system that you don’t really want them here to slave and nation build, or shut up and treat them.
ocrenter
January 14, 2011 @
7:33 PM
Djshakes wrote:Citizens with [quote=Djshakes]Citizens with emergencies…yes. Illegals…no.[/quote]
no where in the constitution guarantee medical care in emergencies.
no insurance, no care. regardless of citizenship.
Anonymous
January 15, 2011 @
6:49 AM
ocrenter wrote:Djshakes [quote=ocrenter][quote=Djshakes]Citizens with emergencies…yes. Illegals…no.[/quote]
no where in the constitution guarantee medical care in emergencies.
no insurance, no care. regardless of citizenship.[/quote]
Tea Baggers have their own version of the Constitution.
briansd1
January 15, 2011 @
7:42 AM
IMO, healthcare should be a IMO, healthcare should be a public service much like road building and maintenance and education.
If you want premium service over and above, you’re welcomed to pay for it.
Excerpts of the Constitution:
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;
GH
January 14, 2011 @
4:24 PM
Looks to me like “mandatory” Looks to me like “mandatory” health insurance will be several thousand dollars a month in a few years if prices keep going up exponentially.
What happens when insurance costs exceed gross incomes? Going to happen pretty soon I think Obamacare or not.
And hell yes if you cannot afford a doctor then bummer. There are lots of things I cannot afford in life that might make me healthier!
Anonymous
January 15, 2011 @
6:47 AM
GH wrote:What happens when [quote=GH]What happens when insurance costs exceed gross incomes? Going to happen pretty soon I think Obamacare or not.[/quote]
You mean:
What happens when *health care* costs exceed gross incomes?
Time to convene the death panels…
OnPoint
January 14, 2011 @
5:25 PM
Open question: How do other Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
I hear conflicting stories about Mexico. Seems like a few years ago there was a rash of gringo car crash victims denied treatment until they came up with cash (after hours of suffering). But a Mexican I know says that’s individuals acting against policy.
???
Eugene
January 15, 2011 @
3:43 PM
OnPoint wrote:Open question: [quote=OnPoint]Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
[/quote]
In most places hospitals treat you and send the bill to the federal government. It normally does not make sense to single out foreigners and migrants and to treat them differently from citizens.
[quote]no where in the constitution guarantee medical care in emergencies.[/quote]
This issue would have been unimaginable when the constitution was written. Back in the 18th century there probably weren’t a single medical treatment that would’ve cost even a poorest laborer more than a day of his wages. These days, a round of chemo & radiotherapy can cost a comparably skilled person two or three years of his wages.
Even if we just got healthcare costs as a share of GDP back to the 1960’s levels, we would be able to design a system where almost everyone could afford to buy health insurance without any subsidies, because a comprehensive low-deductible individual plan would go for $100/month/person.
Anonymous
January 15, 2011 @
8:27 PM
Eugene wrote:Back in the 18th [quote=Eugene]Back in the 18th century…[/quote]
If we look at history, we will notice that medical technology started advancing at a rapid pace around the turn of the 20th century – right around the time Teddy Roosevelt and other progressives initiated their plot to destroy America. It started with vaccinations and antibiotics.
By the time of FDR (another progressive), X-rays were becoming commonplace and we were making advances toward understanding viruses and eventually eliminated polio. Of course this was simply the beginnings of big government: More technology, more “cures” and more costs. The plot to bankrupt America was in full swing.
In the 1960s (Kennedy and the hippies) we saw even more technological developments – organ transplants, advanced imaging and widespread vaccinations. By now, medical technology was big business (regulated by government, of course) and all these newfangled gadgets were even more expensive.
So that’s when the critical component of the leftist plot was launched: Medicare.
After nearly a century of devising ways to increase medical costs, the progressives sprung the trap! – convincing Americans that government must take their money to pay for it all.
If we could restore America back to the 18th century we could eliminate this health care burden and live and die as the Founding Fathers did.
Back then all you needed was a country doctor, a bottle of whiskey and a shovel.
bearishgurl
January 15, 2011 @
8:49 PM
pri_dk wrote: . . . If we [quote=pri_dk] . . . If we could restore America back to the 18th century we could eliminate this health care burden and live and die as the Founding Fathers did.
Back then all you needed was a country doctor, a bottle of whiskey and a shovel.[/quote]
So true, pri dk . . . lol. Don’t really know what all the fuss is about today. The outcome is the same, whether or not one chooses to “mortgage” their (or their heirs) life away.
Eugene
January 16, 2011 @
6:06 AM
Quote:In the 1960s (Kennedy [quote]In the 1960s (Kennedy and the hippies) we saw even more technological developments – organ transplants, advanced imaging and widespread vaccinations. By now, medical technology was big business (regulated by government, of course) and all these newfangled gadgets were even more expensive.[/quote]
Somewhat tangentially, the question that needs to be asked (but never is asked) is, what is the appropriate real cost of these technological developments?
How much does it REALLY cost to transplant a liver?
The evidence we have so far is that, as long as there’s someone willing to foot the bill, a liver transplant can easily run into six digits, or 3-6 person-years at a typical wage.
Even assuming that surgeons who do the transplantation have to be well-trained and deserve to make 5 times the average national wage (which is still a major hypothetical), those surgeons only account for 300 person-hours (3 surgeons times 20 hours times 5x wage), or a small fraction of the final bill.
So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.
Anonymous
January 16, 2011 @
6:41 AM
Eugene wrote:So where does [quote=Eugene]So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.[/quote]
The insurance companies certainly know. They wouldn’t be in business for long if they did not.
Arraya
January 16, 2011 @
8:31 AM
Absolutely, they should be Absolutely, they should be allowed! Our father the market has decreed that the invisible hand shall be arbiter of life and death. Only a godless liberal would get in the way of divine judgement. So it shall be written, so it shall be done.
bubba99
January 18, 2011 @
9:11 AM
Arraya wrote:Absolutely, they [quote=Arraya]Absolutely, they should be allowed! Our father the market has decreed that the invisible hand shall be arbiter of life and death. Only a godless liberal would get in the way of divine judgement. So it shall be written, so it shall be done.[/quote]
Mathew 23, Jesus said onto his disciples,” verily I say unto you that a rich man shall hardly enter the kingdom of heaven”.
Medical costs are just the fathers way of stripping away “all our wealth” to allow us to enter heaven.
CA renter
January 17, 2011 @
10:05 PM
Eugene wrote:Quote:In the [quote=Eugene][quote]In the 1960s (Kennedy and the hippies) we saw even more technological developments – organ transplants, advanced imaging and widespread vaccinations. By now, medical technology was big business (regulated by government, of course) and all these newfangled gadgets were even more expensive.[/quote]
Somewhat tangentially, the question that needs to be asked (but never is asked) is, what is the appropriate real cost of these technological developments?
How much does it REALLY cost to transplant a liver?
The evidence we have so far is that, as long as there’s someone willing to foot the bill, a liver transplant can easily run into six digits, or 3-6 person-years at a typical wage.
Even assuming that surgeons who do the transplantation have to be well-trained and deserve to make 5 times the average national wage (which is still a major hypothetical), those surgeons only account for 300 person-hours (3 surgeons times 20 hours times 5x wage), or a small fraction of the final bill.
So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.[/quote]
This is the best question, Eugene.
I recently had a very minor “surgial” procedure — done in a regular exam room, no OR, only local anesthetic. One radiologist (who did the procedure), one radiology tech, plus one resident who was there to observe and gain experience in the procedure. It probably took them about 30-45 minutes. (Billed) Cost: $4,400. It just seemed awfully high to me.
bobby
January 18, 2011 @
9:45 PM
the “billed” amount is never the “billed” amount is never the “reimbursed” amount. Sometime, the reimbursed amount may be 20% of the billed amount.
The cost may also be for materials used during procedure (drug, contrasts, etc).
the “machine” may cost half a million dollars.
I am not a radiologist and since you didn’t specify the “procedure”, this is best guess.
but then again, radiology is one of the fields where a physician still make good money.
CA renter
January 18, 2011 @
10:17 PM
bobby wrote:the “billed” [quote=bobby]the “billed” amount is never the “reimbursed” amount. Sometime, the reimbursed amount may be 20% of the billed amount.
The cost may also be for materials used during procedure (drug, contrasts, etc).
the “machine” may cost half a million dollars.
I am not a radiologist and since you didn’t specify the “procedure”, this is best guess.
but then again, radiology is one of the fields where a physician still make good money.[/quote]
Yes, I understand the differentiation between the “billed” amount and the “reimbursed” amount, which I why I specified that it was the “billed” amount.
IMHO, there is a big problem when patients (who might be paying out-of-pocket) don’t have access to the “real” costs before getting care. It would be best if all medical procedures would have a set cost, with the “price list” being public information, so that patients could shop around and try to get the best deals.
Why is it that the medical profession can get away with not having transparent pricing, and why are they allowed to play these stupid games with overbilling?
bobby
January 19, 2011 @
12:17 PM
CA renter wrote:
Yes, I [quote=CA renter]
Yes, I understand the differentiation between the “billed” amount and the “reimbursed” amount, which I why I specified that it was the “billed” amount.
IMHO, there is a big problem when patients (who might be paying out-of-pocket) don’t have access to the “real” costs before getting care. It would be best if all medical procedures would have a set cost, with the “price list” being public information, so that patients could shop around and try to get the best deals.
Why is it that the medical profession can get away with not having transparent pricing, and why are they allowed to play these stupid games with overbilling?[/quote]
I was merely responding to the post about the “billed” amount. For an average reader, it would seem that the doctor made out like bandit but he may have only be reimbursed $500 for that time and equipment – which seems like a lot but would barely cover the cost of equipments and personnel.
Yes, billing is one of the most frustrating part of medicine, playing the game with the rules set up by the insurance companies and medicare.
we don’t set up anything, the power is held by the insurance company and we are simply following the rules set by the government.
If this was a non-emergent procedure, the wisest financial move is to negotiate a price before hand.
bobby
January 18, 2011 @
9:41 PM
Eugene wrote:
Somewhat [quote=Eugene]
Somewhat tangentially, the question that needs to be asked (but never is asked) is, what is the appropriate real cost of these technological developments?
How much does it REALLY cost to transplant a liver?
The evidence we have so far is that, as long as there’s someone willing to foot the bill, a liver transplant can easily run into six digits, or 3-6 person-years at a typical wage.
Even assuming that surgeons who do the transplantation have to be well-trained and deserve to make 5 times the average national wage (which is still a major hypothetical), those surgeons only account for 300 person-hours (3 surgeons times 20 hours times 5x wage), or a small fraction of the final bill.
So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.[/quote]
I’m in the health care field.
first of all, a transplant surgeon is very well trained, putting in at least 15 years post secondary education with many of those years doing 80-100 hours / week. Only the best and the brightest makes transplant surgeon. They make (and deserve) more than 5x national average wage. A good lawyer charges 15-20x the national average wage and a transplant surgeon only gets 5x? We redesigned our place and the architect charges $300/hour. Heck, if you bring your Porsche/BMW/Mercedes (I drive a Honda but mostly ride a bicycle to work) to your mechanic, you’ll get $100/hr bill. You think a transplant surgeon should get the same wage as a high-tech mechanic?
what about the teams of nurses and other hospital personnel (who don’t get the credit they deserve) dedicated to taking care of the patient 24/7 for weeks after the actual surgery. A hospital isn’t run by some high school grads but by professionals with many years of training (I’m not talking about doctors). Then there are people behind the scene that the patients never see who are absolutely essential to a good patient outcome (pharmacists, hospital admin, etc).
an ICU nurse gets $30-40/hour x 24 hours (around the clock care – no we don’t punch out after 8 hours). California law states one nurse per two patients. The hospital gets to pay the nurse retirement, insurances, etc.
Think of all the expensive medications the patients have to be on. Transplant meds aren’t cheap.
Think of all the top notch diagnostic machinery to monitor the patient’s progress.
A stay in the hospital is like a 4 star hotel, and that’s just the room.
Imagine a dream vacation: having Tiger Woods golf coach (doctor) tutoring you for a couple of days. staying at the Ritz Carlton with a concierges/masseuse (nurse) sitting bedside 24/7 for two week, renting a Ferrari (machine)everyday and only consuming the best caviar/wine (meds). Now complain about the bill when you check out.
Eugene
January 18, 2011 @
10:31 PM
Quote:A good lawyer charges [quote]A good lawyer charges 15-20x the national average wage and a transplant surgeon only gets 5x? We redesigned our place and the architect charges $300/hour. Heck, if you bring your Porsche/BMW/Mercedes (I drive a Honda but mostly ride a bicycle to work) to your mechanic, you’ll get $100/hr bill. You think a transplant surgeon should get the same wage as a high-tech mechanic? [/quote]
Very few lawyers make 15k the average wage. Some full partners do, but a typical lawyer will make only 3-4x.
The mechanic who works on the Porsche does not make anywhere close to 100/hr, he’ll get to keep 25 tops, the rest goes to pay for the management, electricity, tools, or just pads the pockets of the dealership owner.
[quote]what about the teams of nurses and other hospital personnel (who don’t get the credit they deserve) dedicated to taking care of the patient 24/7 for weeks after the actual surgery.[/quote]
Okay, let’s say that the actual surgery is performed by 3 surgeons + one anesthesiologist, and they are all paid 10x average wage, and it takes 20 hours. That’s $16,000. And the patient stays in the hospital for a week, with one nurse making $30/hour per two patients. That’s another $2,500. Food, electricity, clean bed sheets, call that $1,500 ($200/day, consistent with a stay in a good hotel). We’re up to $20,000.
But in reality, the transplant appears to cost $150,000 to $250,000:
We’re still a long, long, long way from explaining that number.
an
January 18, 2011 @
10:57 PM
Eugene wrote:Quote:A good [quote=Eugene][quote]A good lawyer charges 15-20x the national average wage and a transplant surgeon only gets 5x? We redesigned our place and the architect charges $300/hour. Heck, if you bring your Porsche/BMW/Mercedes (I drive a Honda but mostly ride a bicycle to work) to your mechanic, you’ll get $100/hr bill. You think a transplant surgeon should get the same wage as a high-tech mechanic? [/quote]
Very few lawyers make 15k the average wage. Some full partners do, but a typical lawyer will make only 3-4x.
The mechanic who works on the Porsche does not make anywhere close to 100/hr, he’ll get to keep 25 tops, the rest goes to pay for the management, electricity, tools, or just pads the pockets of the dealership owner.
[quote]what about the teams of nurses and other hospital personnel (who don’t get the credit they deserve) dedicated to taking care of the patient 24/7 for weeks after the actual surgery.[/quote]
Okay, let’s say that the actual surgery is performed by 3 surgeons + one anesthesiologist, and they are all paid 10x average wage, and it takes 20 hours. That’s $16,000. And the patient stays in the hospital for a week, with one nurse making $30/hour per two patients. That’s another $2,500. Food, electricity, clean bed sheets, call that $1,500 ($200/day, consistent with a stay in a good hotel). We’re up to $20,000.
But in reality, the transplant appears to cost $150,000 to $250,000:
We’re still a long, long, long way from explaining that number.[/quote]
You forget charge nurse, mentors, techs, lawyers, CNA, Nursing supervisors, HR (hotel require you to leave your credit card before you check in and charges your credit card at check out vs dealing w/ medicare and various insurance companies), etc. There are probably several other positions that I missed that a hospital need to employ that a hotel does not.
I once was quoted $300 for an oil change at a Mercedes dealership. An oil change probably take them 30 min max (w/ proper tools and skilled tech, they porbably can do it in 15 minutes). That’s $600-$1200/hr. depending on how fast/slow the mechanic is.
bobby
January 19, 2011 @
1:08 PM
duplicated duplicated
bobby
January 19, 2011 @
1:09 PM
Eugene wrote:
Okay, let’s say [quote=Eugene]
Okay, let’s say that the actual surgery is performed by 3 surgeons + one anesthesiologist, and they are all paid 10x average wage, and it takes 20 hours. That’s $16,000. And the patient stays in the hospital for a week, with one nurse making $30/hour per two patients. That’s another $2,500. Food, electricity, clean bed sheets, call that $1,500 ($200/day, consistent with a stay in a good hotel). We’re up to $20,000.
But in reality, the transplant appears to cost $150,000 to $250,000:
We’re still a long, long, long way from explaining that number.[/quote]
a transplant patient, especially liver is quite sick. You’ll need more than 1 nurse and 3 doctors to keep this person alive. It takes likely upward of 50-100 people of at least 10 different fields to keep this person going. Since most of these are highly trained professionals, that’s not going to come cheap.
also, you didn’t include the cost of medicines, equipments, tests, etc.
if this patient is uninsured, the hospital still have to take care of this patient anyway. What happens is they past the cost onto paying/insured patients.
Lastly, a high-risk patients is likely to have bad outcome. In this lawsuit happy country, the hospital must buy insurance. High risk = high premium.
compare this to fixing your honda. A minor fender bender runs you a few thousands. If the car flips over, easily 10-20 grands.
Imagine you have a vintage million dollar car that requires a weeks worth of the best team of craftsmans, mechanics, body specialists working on it 24 hours a day. How much would that run? Keep in mind that car mechanics don’t go to school for 15 years, borrow $300,000 for schooling, and aren’t top 1-2% of graduating college students.
ocrenter
January 16, 2011 @
6:23 AM
OnPoint wrote:Open question: [quote=OnPoint]Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
[/quote]
problem with the answer to this question is most wealthy democracies all have government run universal coverage. (except the US)
the natural progression when a country develops into a wealthy democracy (ie Taiwan or S.Korea) is for them to develop and embrace universal government run healthcare.
UCGal
January 17, 2011 @
6:27 PM
OnPoint wrote:Open question: [quote=OnPoint]Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
[/quote]
A friend was in a 4-wheeler accident in British Columbia, Canada. She was a US citizen. Since she’d just graduated college and hadn’t started working yet, she did not have insurance. (This happened like a month after she graduated college.) She was in a Canadian hospital for 10 days and had 2 orthopedic surgeries in that time. She then returned to the US and did her rehab there. (Badly crushed ankle and foot – she had to learn to walk again.) The Canadian government set her up on a payment plan. The cost was significant, but the terms were fair (5 years to pay it off, no interest). And the cost was a LOT lower than it would have been in the US.
My sister in law had debilitating headaches hit her while travelling in Italy. She went to the local hospital and they gave her treatment, including a brain scan. When she asked about the bill she was told emergency service is covered by the government for tourists.
January 14, 2011 @ 12:52 PM
define treat…
define treat…
January 14, 2011 @ 12:56 PM
Citizens with
Citizens with emergencies…yes. Illegals…no.
January 14, 2011 @ 1:05 PM
Only people who have served
Only people who have served in the military or agree to serve in the military in the future illegal or not.
January 14, 2011 @ 1:09 PM
What make them so special?
What make them so special? Most people enter the military only because they can’t find good jobs.
[quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
January 14, 2011 @ 1:18 PM
EmilyHicks wrote:What make
[quote=EmilyHicks]What make them so special? Most people enter the military only because they can’t find good jobs.
[quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote][/quote]
Yes, what makes people who can’t find good jobs with health care special?
January 14, 2011 @ 1:43 PM
Yes.
Yes.
January 15, 2011 @ 8:02 PM
Rustico wrote:Only people who
[quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
If you want to honor the Armed Uniformed Services,
will you include the Post Office?
January 16, 2011 @ 6:24 AM
patb wrote:Rustico wrote:Only
[quote=patb][quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
If you want to honor the Armed Uniformed Services,
will you include the Post Office?[/quote]
well, some of them certainly are armed…
January 16, 2011 @ 8:51 AM
ocrenter wrote:patb
[quote=ocrenter][quote=patb][quote=Rustico]Only people who have served in the military or agree to serve in the military in the future illegal or not.[/quote]
If you want to honor the Armed Uniformed Services,
will you include the Post Office?[/quote]
well, some of them certainly are armed…[/quote]
I am a veteran and sometimes I go postal, damn right we should all have health care, civilians too, any of them. Treat illegals, and then kick them out if you have to, prove to me mr. system that you don’t really want them here to slave and nation build, or shut up and treat them.
January 14, 2011 @ 7:33 PM
Djshakes wrote:Citizens with
[quote=Djshakes]Citizens with emergencies…yes. Illegals…no.[/quote]
no where in the constitution guarantee medical care in emergencies.
no insurance, no care. regardless of citizenship.
January 15, 2011 @ 6:49 AM
ocrenter wrote:Djshakes
[quote=ocrenter][quote=Djshakes]Citizens with emergencies…yes. Illegals…no.[/quote]
no where in the constitution guarantee medical care in emergencies.
no insurance, no care. regardless of citizenship.[/quote]
Tea Baggers have their own version of the Constitution.
January 15, 2011 @ 7:42 AM
IMO, healthcare should be a
IMO, healthcare should be a public service much like road building and maintenance and education.
If you want premium service over and above, you’re welcomed to pay for it.
Excerpts of the Constitution:
January 14, 2011 @ 4:24 PM
Looks to me like “mandatory”
Looks to me like “mandatory” health insurance will be several thousand dollars a month in a few years if prices keep going up exponentially.
What happens when insurance costs exceed gross incomes? Going to happen pretty soon I think Obamacare or not.
And hell yes if you cannot afford a doctor then bummer. There are lots of things I cannot afford in life that might make me healthier!
January 15, 2011 @ 6:47 AM
GH wrote:What happens when
[quote=GH]What happens when insurance costs exceed gross incomes? Going to happen pretty soon I think Obamacare or not.[/quote]
You mean:
What happens when *health care* costs exceed gross incomes?
Time to convene the death panels…
January 14, 2011 @ 5:25 PM
Open question: How do other
Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
I hear conflicting stories about Mexico. Seems like a few years ago there was a rash of gringo car crash victims denied treatment until they came up with cash (after hours of suffering). But a Mexican I know says that’s individuals acting against policy.
???
January 15, 2011 @ 3:43 PM
OnPoint wrote:Open question:
[quote=OnPoint]Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
[/quote]
In most places hospitals treat you and send the bill to the federal government. It normally does not make sense to single out foreigners and migrants and to treat them differently from citizens.
[quote]no where in the constitution guarantee medical care in emergencies.[/quote]
This issue would have been unimaginable when the constitution was written. Back in the 18th century there probably weren’t a single medical treatment that would’ve cost even a poorest laborer more than a day of his wages. These days, a round of chemo & radiotherapy can cost a comparably skilled person two or three years of his wages.
Even if we just got healthcare costs as a share of GDP back to the 1960’s levels, we would be able to design a system where almost everyone could afford to buy health insurance without any subsidies, because a comprehensive low-deductible individual plan would go for $100/month/person.
January 15, 2011 @ 8:27 PM
Eugene wrote:Back in the 18th
[quote=Eugene]Back in the 18th century…[/quote]
If we look at history, we will notice that medical technology started advancing at a rapid pace around the turn of the 20th century – right around the time Teddy Roosevelt and other progressives initiated their plot to destroy America. It started with vaccinations and antibiotics.
By the time of FDR (another progressive), X-rays were becoming commonplace and we were making advances toward understanding viruses and eventually eliminated polio. Of course this was simply the beginnings of big government: More technology, more “cures” and more costs. The plot to bankrupt America was in full swing.
In the 1960s (Kennedy and the hippies) we saw even more technological developments – organ transplants, advanced imaging and widespread vaccinations. By now, medical technology was big business (regulated by government, of course) and all these newfangled gadgets were even more expensive.
So that’s when the critical component of the leftist plot was launched: Medicare.
After nearly a century of devising ways to increase medical costs, the progressives sprung the trap! – convincing Americans that government must take their money to pay for it all.
If we could restore America back to the 18th century we could eliminate this health care burden and live and die as the Founding Fathers did.
Back then all you needed was a country doctor, a bottle of whiskey and a shovel.
January 15, 2011 @ 8:49 PM
pri_dk wrote: . . . If we
[quote=pri_dk] . . . If we could restore America back to the 18th century we could eliminate this health care burden and live and die as the Founding Fathers did.
Back then all you needed was a country doctor, a bottle of whiskey and a shovel.[/quote]
So true, pri dk . . . lol. Don’t really know what all the fuss is about today. The outcome is the same, whether or not one chooses to “mortgage” their (or their heirs) life away.
January 16, 2011 @ 6:06 AM
Quote:In the 1960s (Kennedy
[quote]In the 1960s (Kennedy and the hippies) we saw even more technological developments – organ transplants, advanced imaging and widespread vaccinations. By now, medical technology was big business (regulated by government, of course) and all these newfangled gadgets were even more expensive.[/quote]
Somewhat tangentially, the question that needs to be asked (but never is asked) is, what is the appropriate real cost of these technological developments?
How much does it REALLY cost to transplant a liver?
The evidence we have so far is that, as long as there’s someone willing to foot the bill, a liver transplant can easily run into six digits, or 3-6 person-years at a typical wage.
Even assuming that surgeons who do the transplantation have to be well-trained and deserve to make 5 times the average national wage (which is still a major hypothetical), those surgeons only account for 300 person-hours (3 surgeons times 20 hours times 5x wage), or a small fraction of the final bill.
So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.
January 16, 2011 @ 6:41 AM
Eugene wrote:So where does
[quote=Eugene]So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.[/quote]
The insurance companies certainly know. They wouldn’t be in business for long if they did not.
January 16, 2011 @ 8:31 AM
Absolutely, they should be
Absolutely, they should be allowed! Our father the market has decreed that the invisible hand shall be arbiter of life and death. Only a godless liberal would get in the way of divine judgement. So it shall be written, so it shall be done.
January 18, 2011 @ 9:11 AM
Arraya wrote:Absolutely, they
[quote=Arraya]Absolutely, they should be allowed! Our father the market has decreed that the invisible hand shall be arbiter of life and death. Only a godless liberal would get in the way of divine judgement. So it shall be written, so it shall be done.[/quote]
Mathew 23, Jesus said onto his disciples,” verily I say unto you that a rich man shall hardly enter the kingdom of heaven”.
Medical costs are just the fathers way of stripping away “all our wealth” to allow us to enter heaven.
January 17, 2011 @ 10:05 PM
Eugene wrote:Quote:In the
[quote=Eugene][quote]In the 1960s (Kennedy and the hippies) we saw even more technological developments – organ transplants, advanced imaging and widespread vaccinations. By now, medical technology was big business (regulated by government, of course) and all these newfangled gadgets were even more expensive.[/quote]
Somewhat tangentially, the question that needs to be asked (but never is asked) is, what is the appropriate real cost of these technological developments?
How much does it REALLY cost to transplant a liver?
The evidence we have so far is that, as long as there’s someone willing to foot the bill, a liver transplant can easily run into six digits, or 3-6 person-years at a typical wage.
Even assuming that surgeons who do the transplantation have to be well-trained and deserve to make 5 times the average national wage (which is still a major hypothetical), those surgeons only account for 300 person-hours (3 surgeons times 20 hours times 5x wage), or a small fraction of the final bill.
So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.[/quote]
This is the best question, Eugene.
I recently had a very minor “surgial” procedure — done in a regular exam room, no OR, only local anesthetic. One radiologist (who did the procedure), one radiology tech, plus one resident who was there to observe and gain experience in the procedure. It probably took them about 30-45 minutes. (Billed) Cost: $4,400. It just seemed awfully high to me.
January 18, 2011 @ 9:45 PM
the “billed” amount is never
the “billed” amount is never the “reimbursed” amount. Sometime, the reimbursed amount may be 20% of the billed amount.
The cost may also be for materials used during procedure (drug, contrasts, etc).
the “machine” may cost half a million dollars.
I am not a radiologist and since you didn’t specify the “procedure”, this is best guess.
but then again, radiology is one of the fields where a physician still make good money.
January 18, 2011 @ 10:17 PM
bobby wrote:the “billed”
[quote=bobby]the “billed” amount is never the “reimbursed” amount. Sometime, the reimbursed amount may be 20% of the billed amount.
The cost may also be for materials used during procedure (drug, contrasts, etc).
the “machine” may cost half a million dollars.
I am not a radiologist and since you didn’t specify the “procedure”, this is best guess.
but then again, radiology is one of the fields where a physician still make good money.[/quote]
Yes, I understand the differentiation between the “billed” amount and the “reimbursed” amount, which I why I specified that it was the “billed” amount.
IMHO, there is a big problem when patients (who might be paying out-of-pocket) don’t have access to the “real” costs before getting care. It would be best if all medical procedures would have a set cost, with the “price list” being public information, so that patients could shop around and try to get the best deals.
Why is it that the medical profession can get away with not having transparent pricing, and why are they allowed to play these stupid games with overbilling?
January 19, 2011 @ 12:17 PM
CA renter wrote:
Yes, I
[quote=CA renter]
Yes, I understand the differentiation between the “billed” amount and the “reimbursed” amount, which I why I specified that it was the “billed” amount.
IMHO, there is a big problem when patients (who might be paying out-of-pocket) don’t have access to the “real” costs before getting care. It would be best if all medical procedures would have a set cost, with the “price list” being public information, so that patients could shop around and try to get the best deals.
Why is it that the medical profession can get away with not having transparent pricing, and why are they allowed to play these stupid games with overbilling?[/quote]
I was merely responding to the post about the “billed” amount. For an average reader, it would seem that the doctor made out like bandit but he may have only be reimbursed $500 for that time and equipment – which seems like a lot but would barely cover the cost of equipments and personnel.
Yes, billing is one of the most frustrating part of medicine, playing the game with the rules set up by the insurance companies and medicare.
we don’t set up anything, the power is held by the insurance company and we are simply following the rules set by the government.
If this was a non-emergent procedure, the wisest financial move is to negotiate a price before hand.
January 18, 2011 @ 9:41 PM
Eugene wrote:
Somewhat
[quote=Eugene]
Somewhat tangentially, the question that needs to be asked (but never is asked) is, what is the appropriate real cost of these technological developments?
How much does it REALLY cost to transplant a liver?
The evidence we have so far is that, as long as there’s someone willing to foot the bill, a liver transplant can easily run into six digits, or 3-6 person-years at a typical wage.
Even assuming that surgeons who do the transplantation have to be well-trained and deserve to make 5 times the average national wage (which is still a major hypothetical), those surgeons only account for 300 person-hours (3 surgeons times 20 hours times 5x wage), or a small fraction of the final bill.
So where does the money go? I’d like to know, but I don’t. I don’t think anybody does.[/quote]
I’m in the health care field.
first of all, a transplant surgeon is very well trained, putting in at least 15 years post secondary education with many of those years doing 80-100 hours / week. Only the best and the brightest makes transplant surgeon. They make (and deserve) more than 5x national average wage. A good lawyer charges 15-20x the national average wage and a transplant surgeon only gets 5x? We redesigned our place and the architect charges $300/hour. Heck, if you bring your Porsche/BMW/Mercedes (I drive a Honda but mostly ride a bicycle to work) to your mechanic, you’ll get $100/hr bill. You think a transplant surgeon should get the same wage as a high-tech mechanic?
what about the teams of nurses and other hospital personnel (who don’t get the credit they deserve) dedicated to taking care of the patient 24/7 for weeks after the actual surgery. A hospital isn’t run by some high school grads but by professionals with many years of training (I’m not talking about doctors). Then there are people behind the scene that the patients never see who are absolutely essential to a good patient outcome (pharmacists, hospital admin, etc).
an ICU nurse gets $30-40/hour x 24 hours (around the clock care – no we don’t punch out after 8 hours). California law states one nurse per two patients. The hospital gets to pay the nurse retirement, insurances, etc.
Think of all the expensive medications the patients have to be on. Transplant meds aren’t cheap.
Think of all the top notch diagnostic machinery to monitor the patient’s progress.
A stay in the hospital is like a 4 star hotel, and that’s just the room.
Imagine a dream vacation: having Tiger Woods golf coach (doctor) tutoring you for a couple of days. staying at the Ritz Carlton with a concierges/masseuse (nurse) sitting bedside 24/7 for two week, renting a Ferrari (machine)everyday and only consuming the best caviar/wine (meds). Now complain about the bill when you check out.
January 18, 2011 @ 10:31 PM
Quote:A good lawyer charges
[quote]A good lawyer charges 15-20x the national average wage and a transplant surgeon only gets 5x? We redesigned our place and the architect charges $300/hour. Heck, if you bring your Porsche/BMW/Mercedes (I drive a Honda but mostly ride a bicycle to work) to your mechanic, you’ll get $100/hr bill. You think a transplant surgeon should get the same wage as a high-tech mechanic? [/quote]
Very few lawyers make 15k the average wage. Some full partners do, but a typical lawyer will make only 3-4x.
The mechanic who works on the Porsche does not make anywhere close to 100/hr, he’ll get to keep 25 tops, the rest goes to pay for the management, electricity, tools, or just pads the pockets of the dealership owner.
[quote]what about the teams of nurses and other hospital personnel (who don’t get the credit they deserve) dedicated to taking care of the patient 24/7 for weeks after the actual surgery.[/quote]
Okay, let’s say that the actual surgery is performed by 3 surgeons + one anesthesiologist, and they are all paid 10x average wage, and it takes 20 hours. That’s $16,000. And the patient stays in the hospital for a week, with one nurse making $30/hour per two patients. That’s another $2,500. Food, electricity, clean bed sheets, call that $1,500 ($200/day, consistent with a stay in a good hotel). We’re up to $20,000.
But in reality, the transplant appears to cost $150,000 to $250,000:
http://www.hepatitis.va.gov/vahep?page=trans-01-07
We’re still a long, long, long way from explaining that number.
January 18, 2011 @ 10:57 PM
Eugene wrote:Quote:A good
[quote=Eugene][quote]A good lawyer charges 15-20x the national average wage and a transplant surgeon only gets 5x? We redesigned our place and the architect charges $300/hour. Heck, if you bring your Porsche/BMW/Mercedes (I drive a Honda but mostly ride a bicycle to work) to your mechanic, you’ll get $100/hr bill. You think a transplant surgeon should get the same wage as a high-tech mechanic? [/quote]
Very few lawyers make 15k the average wage. Some full partners do, but a typical lawyer will make only 3-4x.
The mechanic who works on the Porsche does not make anywhere close to 100/hr, he’ll get to keep 25 tops, the rest goes to pay for the management, electricity, tools, or just pads the pockets of the dealership owner.
[quote]what about the teams of nurses and other hospital personnel (who don’t get the credit they deserve) dedicated to taking care of the patient 24/7 for weeks after the actual surgery.[/quote]
Okay, let’s say that the actual surgery is performed by 3 surgeons + one anesthesiologist, and they are all paid 10x average wage, and it takes 20 hours. That’s $16,000. And the patient stays in the hospital for a week, with one nurse making $30/hour per two patients. That’s another $2,500. Food, electricity, clean bed sheets, call that $1,500 ($200/day, consistent with a stay in a good hotel). We’re up to $20,000.
But in reality, the transplant appears to cost $150,000 to $250,000:
http://www.hepatitis.va.gov/vahep?page=trans-01-07
We’re still a long, long, long way from explaining that number.[/quote]
You forget charge nurse, mentors, techs, lawyers, CNA, Nursing supervisors, HR (hotel require you to leave your credit card before you check in and charges your credit card at check out vs dealing w/ medicare and various insurance companies), etc. There are probably several other positions that I missed that a hospital need to employ that a hotel does not.
I once was quoted $300 for an oil change at a Mercedes dealership. An oil change probably take them 30 min max (w/ proper tools and skilled tech, they porbably can do it in 15 minutes). That’s $600-$1200/hr. depending on how fast/slow the mechanic is.
January 19, 2011 @ 1:08 PM
duplicated
duplicated
January 19, 2011 @ 1:09 PM
Eugene wrote:
Okay, let’s say
[quote=Eugene]
Okay, let’s say that the actual surgery is performed by 3 surgeons + one anesthesiologist, and they are all paid 10x average wage, and it takes 20 hours. That’s $16,000. And the patient stays in the hospital for a week, with one nurse making $30/hour per two patients. That’s another $2,500. Food, electricity, clean bed sheets, call that $1,500 ($200/day, consistent with a stay in a good hotel). We’re up to $20,000.
But in reality, the transplant appears to cost $150,000 to $250,000:
We’re still a long, long, long way from explaining that number.[/quote]
a transplant patient, especially liver is quite sick. You’ll need more than 1 nurse and 3 doctors to keep this person alive. It takes likely upward of 50-100 people of at least 10 different fields to keep this person going. Since most of these are highly trained professionals, that’s not going to come cheap.
also, you didn’t include the cost of medicines, equipments, tests, etc.
if this patient is uninsured, the hospital still have to take care of this patient anyway. What happens is they past the cost onto paying/insured patients.
Lastly, a high-risk patients is likely to have bad outcome. In this lawsuit happy country, the hospital must buy insurance. High risk = high premium.
compare this to fixing your honda. A minor fender bender runs you a few thousands. If the car flips over, easily 10-20 grands.
Imagine you have a vintage million dollar car that requires a weeks worth of the best team of craftsmans, mechanics, body specialists working on it 24 hours a day. How much would that run? Keep in mind that car mechanics don’t go to school for 15 years, borrow $300,000 for schooling, and aren’t top 1-2% of graduating college students.
January 16, 2011 @ 6:23 AM
OnPoint wrote:Open question:
[quote=OnPoint]Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
[/quote]
problem with the answer to this question is most wealthy democracies all have government run universal coverage. (except the US)
the natural progression when a country develops into a wealthy democracy (ie Taiwan or S.Korea) is for them to develop and embrace universal government run healthcare.
January 17, 2011 @ 6:27 PM
OnPoint wrote:Open question:
[quote=OnPoint]Open question: How do other wealthy democracies handle this issue?
E.g., if I go to an emergency room in Canada/Japan/Germany/France/Italy et al, what happens?
[/quote]
A friend was in a 4-wheeler accident in British Columbia, Canada. She was a US citizen. Since she’d just graduated college and hadn’t started working yet, she did not have insurance. (This happened like a month after she graduated college.) She was in a Canadian hospital for 10 days and had 2 orthopedic surgeries in that time. She then returned to the US and did her rehab there. (Badly crushed ankle and foot – she had to learn to walk again.) The Canadian government set her up on a payment plan. The cost was significant, but the terms were fair (5 years to pay it off, no interest). And the cost was a LOT lower than it would have been in the US.
My sister in law had debilitating headaches hit her while travelling in Italy. She went to the local hospital and they gave her treatment, including a brain scan. When she asked about the bill she was told emergency service is covered by the government for tourists.
Those are the two data points I know, personally.