"You call up doctors and ask the price…"

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Submitted by harvey on February 15, 2017 - 9:03pm

https://www.washingtonpost.com/news/powe...

I'm very much an advocate of market-based economies, but I also understand there are limitations. Healthcare is way too complex to allow every transaction to be negotiated by the end consumer. The plan presented by the "Freedom Caucus" is an absolute disaster.

I expect that "repeal and replace" will get mired in gridlock as the Republicans obviously never had an alternative in the past six years. But they now are under tremendous pressure to do something, so there is a good chance we will get legislation that is desperate and half-baked.

My advice to anyone that does not have a decent employer-provided health insurance plan: Don't get sick in the next few years.

Submitted by outtamojo on February 15, 2017 - 10:15pm.

haha when they hear the sound of fear and pain in your voice they jack up the price.

Submitted by moneymaker on February 16, 2017 - 7:45am.

I apologize as I am responsible for higher medical prices, don't have a doctor or take medicine so they have to get their money from other people like you. If people boycotted doctors and drugs do you think prices would go down or up? Obviously I don't have an MRI machine at home or do surgery on myself so I'm also at their whim. My brother got an MRI recently and was charged $2900 just to interpret it, ridiculous!

Submitted by harvey on February 16, 2017 - 8:30am.

moneymaker wrote:
I apologize as I am responsible for higher medical prices, don't have a doctor or take medicine so they have to get their money from other people like you. If people boycotted doctors and drugs do you think prices would go down or up? Obviously I don't have an MRI machine at home or do surgery on myself so I'm also at their whim. My brother got an MRI recently and was charged $2900 just to interpret it, ridiculous!

Soon your brother will be able to haggle for a better price!

Pro tip: Stay conscious during any medical procedure. General anesthesia can hamper negotiating skills.

Submitted by FlyerInHi on February 16, 2017 - 10:35am.

Republicans are in a pickle.
Right now, with the mandate, young people are paying for old folks who voted for Trump.

Republicans, by undermining their own plan (Obamacare is just market based healthcare they wanted before), may cause the pitchforks to demand Medicare for all in the future.

The opioid epidemic is sweeping the red states. It's now worse than the inner cities which are gentrifying. Opioids and out of wedlock pregnancies are now rural problems. But the rural folks and Trump still live in decades past.

But no worries.... nothing more prayers, family values and bootstrapping can't solve.

Submitted by ucodegen on February 16, 2017 - 12:11pm.

harvey wrote:
moneymaker wrote:
I apologize as I am responsible for higher medical prices, don't have a doctor or take medicine so they have to get their money from other people like you. If people boycotted doctors and drugs do you think prices would go down or up? Obviously I don't have an MRI machine at home or do surgery on myself so I'm also at their whim. My brother got an MRI recently and was charged $2900 just to interpret it, ridiculous!

Soon your brother will be able to haggle for a better price!

Pro tip: Stay conscious during any medical procedure. General anesthesia can hamper negotiating skills.


I negotiated mine... $610 for full upper body (guggle to zatch).
They obviously preferred cash.

Submitted by spdrun on February 16, 2017 - 12:25pm.

You shouldn't have to negotiate it.

Good parts of the Repubes' plan...
(1) Subsidies appear to be here to stay
(2) By allowing premiums to pass through a taxfree HSA, it effectively extends the self-employed health insurance tax credit to W-2 wage earners who are not insured. Why do this in such a convoluted way?

Hopefully, states will require insurance (a la Massachusetts pre-ACA) and set quality controls on what polities are acceptable, as well as community-rating like NY did pre-ACA and still does.

Submitted by outtamojo on February 16, 2017 - 2:20pm.

harvey wrote:
moneymaker wrote:
I apologize as I am responsible for higher medical prices, don't have a doctor or take medicine so they have to get their money from other people like you. If people boycotted doctors and drugs do you think prices would go down or up? Obviously I don't have an MRI machine at home or do surgery on myself so I'm also at their whim. My brother got an MRI recently and was charged $2900 just to interpret it, ridiculous!

Soon your brother will be able to haggle for a better price!

Pro tip: Stay conscious during any medical procedure. General anesthesia can hamper negotiating skills.

Yes try not to slur your speech after your stroke, that will also hamper your negotiating.

Submitted by harvey on February 16, 2017 - 2:46pm.

spdrun wrote:
You shouldn't have to negotiate it.

Good parts of the Repubes' plan...
(1) Subsidies appear to be here to stay

You mean SOCIALIST WEALTH CONFISCATION!

Oh wait .... when the Republicans do it, it's FREEDOM!

I haven't heard that subsides are still on the table. It will be entertaining to watch the spin if subsidies are part of the solution.

Quote:
(2) By allowing premiums to pass through a taxfree HSA, it effectively extends the self-employed health insurance tax credit to W-2 wage earners who are not insured. Why do this in such a convoluted way?

Individual premiums should have always been tax-deductible. I have no idea why this wasn't the case all along. Actually I do know why. Because it would cost the government money and individuals don't have lobbies like large employers do. But maybe they'll at least get this part right.

Quote:
Hopefully, states will require insurance (a la Massachusetts pre-ACA) and set quality controls on what polities are acceptable, as well as community-rating like NY did pre-ACA and still does.

I'm sure the larger blue states will at least offer a solution that is not completely worthless. Everyone else can start saving up for that broken leg.

Submitted by FlyerInHi on February 16, 2017 - 4:15pm.

Tax deductions are worthless for middle and lower class Americans because they don't have total deductions greater than the standard.

New report shows that welfare benefits working class Whites more. Obamacare was a convenient issue ginned up to rile up the pitchforks. But it's Obamacare was developed in right wing think tanks as an alternative to euro style health care.

We should just sit back and let Republicans take the blame for healthcare. Those of us who have earthy crunchy lifestyles don't need much medicine anyway.

Submitted by spdrun on February 16, 2017 - 4:38pm.

Depends how they're structured. Self-employed health insurance deduction is over and above the standard one.

Submitted by Reality on February 16, 2017 - 9:07pm.

moneymaker wrote:
I apologize as I am responsible for higher medical prices, don't have a doctor or take medicine so they have to get their money from other people like you.

If you have insurance they are getting it from you too. Your premiums are subsidizing the high utilizers.

Submitted by SK in CV on February 16, 2017 - 9:45pm.

FlyerInHi wrote:

We should just sit back and let Republicans take the blame for healthcare. Those of us who have earthy crunchy lifestyles don't need much medicine anyway.

While you're sitting back and blaming republicans, what am I supposed to do to if I develop a serious medical condition that requires hospitalization? Absent the ACA, I'm uninsurable.

Submitted by FlyerInHi on February 16, 2017 - 11:04pm.

SK in CV wrote:
FlyerInHi wrote:

We should just sit back and let Republicans take the blame for healthcare. Those of us who have earthy crunchy lifestyles don't need much medicine anyway.

While you're sitting back and blaming republicans, what am I supposed to do to if I develop a serious medical condition that requires hospitalization? Absent the ACA, I'm uninsurable.

I'm being glib here. But you have shoes right? You can move to a state where you can get health care. I was watching Tucker Carlson on Fox and he was interviewing someone. They were having a good laugh about puttin' on shoes.

Not you, but lots of people on Obamacare think it sucks and they voted for Trump. Maybe when they face cancellation and no replacement, they can join the demonstrators on the streets to demand Medicare for all, or VA tor all.

As one who helps my elderly relatives manage health care, i think government run VA for all, with rationing, would be best. Right now, the system is so complex that the average American can't understand it.

Submitted by millennial on February 17, 2017 - 12:34am.

My old employer offered a free high deductible plan and offered to contribute $2K a year in an HSA. Was the best plan I had when I was young. I was able to put the money in an investment related account every year and would put the difference between that plan and a traditional PPO into the HSA as well. The high deductible plan offered no deductible for annual checkups and I would call doctors and price shop when I had a bad cold. I remember calling doctors and asking for a price to get some antibiotics and prices ranged from $100-$450 just to check me out and write me a prescription. Did this for about 10 years in my 20s and lucky enough only needed to max out on the out of pocket one year when I needed a surgery. Now that I'm older and have a family we use my wife's HMO but still have a lot of money in the HSA for all our medical needs going forward. Honestly if all employers could offer something similar to young people I think it could be beneficial and self insure many for a good part of their lives.

Submitted by moneymaker on February 17, 2017 - 3:17am.

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?

Submitted by harvey on February 17, 2017 - 7:47am.

moneymaker wrote:
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?

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.

Submitted by FlyerInHi on February 17, 2017 - 10:58am.

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?

Submitted by kev374 on February 17, 2017 - 11:43am.

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.

Submitted by harvey on February 17, 2017 - 11:59am.

kev374 wrote:
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.

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?

Submitted by FlyerInHi on February 27, 2017 - 3:12am.

John Oliver explained it pretty well.

https://youtu.be/YEGpriv2TAc

Submitted by no_such_reality on February 27, 2017 - 8:18am.

kev374 wrote:
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.

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.

Submitted by harvey on February 27, 2017 - 8:39am.

no_such_reality wrote:
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.

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!

Submitted by no_such_reality on February 27, 2017 - 9:03am.

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...

Submitted by harvey on February 27, 2017 - 12:37pm.

no_such_reality wrote:
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.

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...

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.

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...

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

Submitted by FlyerInHi on March 4, 2017 - 12:07am.

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/plu...

Submitted by no_such_reality on March 4, 2017 - 8:51am.

FlyerInHi wrote:
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

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.

Submitted by harvey on March 4, 2017 - 11:17am.

no_such_reality wrote:
Seems pretty obvious were to cut inefficiencies to me.

That last sentence perfectly illustrates the quality of your argument.

Submitted by FlyerInHi on March 4, 2017 - 12:58pm.

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.

Submitted by no_such_reality on March 4, 2017 - 3:34pm.

FlyerInHi wrote:
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.

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.

Submitted by FlyerInHi on March 4, 2017 - 6:30pm.

We do want to pay the bills. Republicans don't; so it's their job to explain to us and make good on their promises.

Obamacare, is an imperfect program to put more resources into covering more people. It succeeded

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