Medical costs

two_bit_score · Nov 8, 2017

Dadnatron said:
The reason is simply that the MD contracts with the facility. There is a facility fee ie you pay for the ER which covers Nurse, support, supplies, etc. And then there is what is called the 'Professional fee' which is the MD's part of the charge.

This was instilled long ago by most hospitals because the facility fee was so lucrative. The Docs are paid separately and most often are simply 'private contractors' with the Hospital, not direct employees. If you were to sue... you would have to sue each separately rather than get a 2 for 1.

I know it is frustrating, and my practice bills what is called a 'Global' bill, in which there is a SINGLE bill, essentially paid to the MD who then pays a % to the facility.

The real travisty is going to ANY hospital for ANY reason other than true life or death. You will pay more than 10X for the same care by the same MD if you see them in the ER rather than a 'Med Check' type facility.

In fact, I have a patient, whom I saw a couple weeks ago and recommended doing a specific procedure. She said it would cost her $6200 at the hospital. I told her to stop by my front office and get a 'Cash Quote' from my office before she left. I said if it is any more than 1/10th the cost she paid for the first 'In Hospital' procedure (same thing I recommended repeating) I'd do it for free. I was notified today that she is on my schedule for tomorrow with a quote just over 1/20th of what the hospital would charge if I did it there.

Obamacare was a joke... and cost far more than it helped. It didn't cause this, but rather than address it, it pretended to 'do something' by looking at the number of people who 'have insurance' rather than can get medical care. Its like handing out empty plates and declaring you have cured World Hunger.

:thumbsup:

This needs to be said at least twice.

TCowner · Nov 9, 2017

No where in the constitution is there any requirement for every citizen to have basic liability insurance coverage on our vehicles. But if we don't, we violate the law and are subject to arrest. I don't see why the requirement that all citizens have at least basic health insurance drove every conservative crazy. Insurance is a way of sharing risk.

When I was young I was absolutely certain I would never get sick. When I was 18 years old and in need of cash for cars, motorcycles and entertainment, and had my employer offered me the option of more money or health insurance I probably would have taken the option of more money. Of course I made the mistake of getting older and after numerous knee surgeries, trips to the Emergency room for various reasons, it became obvious hat I might need some healthcare from time to time. And now,, I am glad that my employer didn't give me the option.

Asking young people, who at the moment may not need much healthcare, to participate in the "risk pool" doesn't seem like a crazy idea. It is possible that these same "young people" will get old and need healthcare. Additionally, as many have said here, catching a small problem when we are 30 is much cheaper to deal with than when the condition worsens and becomes life threatening and expensive when we are 60.

Dadnatron · Nov 9, 2017

TCowner said:
No where in the constitution is there any requirement for every citizen to have basic liability insurance coverage on our vehicles. But if we don't, we violate the law and are subject to arrest. I don't see why the requirement that all citizens have at least basic health insurance drove every conservative crazy. Insurance is a way of sharing risk.

The way insurance currently works... the nuts and bolts... is why health care is so expensive. NOT the doctors... but the system.

That, and the fact that Health Care is no longer ran by Doctors... it is purely ran as a business by MBAs who see nothing more than a pool of $$$ which can be manipulated and exploited just like any other business.

People 'pre-pay' thinking that after that... they can and DESERVE to have the BEST of everything at any time. This is the current 'insurance system'. 40 years ago, patients were 'reimbursed' by insurance. Now, they blindly pay, most without EVER actually seeing the money to begin with. Insurance premiums are removed from their check by their employer long before that $ ever gets into a bank account. So, not only is there a 'I deserve this' feeling, but it is also, in a large % of people, felt to be a RIGHT because they've never actually had to write a check.

Insurance will always make money... because they are just the middle man in a highly sought after business. They are LEGALLY (via Obamacare) able to take 20% off the top to work with it in any way they choose. So, think about this...

Example: Insurance in 1980, appendectomy cost $500 total. Insurance paid 80% You paid 20%, but you paid a premium for that year of $500 so they made $100 off you. This is fair IMO.

Today: Insurance in 2017, appendectomy costs $12,000 total. Insurance pays 80% after deductible of $6K and you pay a premium of $10K for the privilege. Utilizing Insurance as it currently stands after Obamacare costs you $16K for a $12K procedure.

And furthermore, think about this... Insurance, as it stands makes roughly 10% of everything they bring in, until the craziness of O-care in which they still haven't figured out how it works, so this doesn't quite hold up right now. But, if they make 10%... they are encouraged to INCREASE the costs of healthcare rather than decrease. If $1M flows through their accounts, they earn $100K If $1B flows through their accounts, they earn $100M. This is the genius of health Insurance as a business. They are simply the middle men, they will increase the premiums until they are getting their 10% and its always better to pay $10,000 and charge YOU a higher premiun and take in 10% - than to pay $1000 and charge you a lower premium and take 10% of that payment.

MBAs have screwed up healthcare far more than MDs. Although, the MDs of 40yrs ago went along for a GRAND RIDE. They made a killing in the system when it was in its prime. Now, the only ones making money are investors in the companies, and the CEOs with Golden Parachutes.

Don't get me wrong... docs do well. But it only comes after a HUGE amount of work. Took me 16yrs after HS to get my first Staff MD paycheck.

LD1 · Nov 9, 2017

TCowner said:
No where in the constitution is there any requirement for every citizen to have basic liability insurance coverage on our vehicles. But if we don't, we violate the law and are subject to arrest. I don't see why the requirement that all citizens have at least basic health insurance drove every conservative crazy. Insurance is a way of sharing risk.

When I was young I was absolutely certain I would never get sick. When I was 18 years old and in need of cash for cars, motorcycles and entertainment, and had my employer offered me the option of more money or health insurance I probably would have taken the option of more money. Of course I made the mistake of getting older and after numerous knee surgeries, trips to the Emergency room for various reasons, it became obvious hat I might need some healthcare from time to time. And now,, I am glad that my employer didn't give me the option.

Asking young people, who at the moment may not need much healthcare, to participate in the "risk pool" doesn't seem like a crazy idea. It is possible that these same "young people" will get old and need healthcare. Additionally, as many have said here, catching a small problem when we are 30 is much cheaper to deal with than when the condition worsens and becomes life threatening and expensive when we are 60.

The difference.....living is a God given right.

Driving is a privilege.

You simply cannot force someone to buy something (especially if they cannot afford it) simply for living. The government has no right to force you to buy anything.

Driving is a choice. And a privilege. Government does NOT force you to buy auto insurance. Don't believe me, sell your car and see if they still make you buy it.

If you CHOOSE to indulge on the luxury of driving a car, (rather than taxi, public transport, bicycle, Uber, etc) then you are agreeing to carry the insurance that goes with it

Dadnatron · Nov 9, 2017

Redneck in training said:
There is nothing in about roads, electric grid and power generation, internet and in general infrastructure in constitutionm either. Can you imagine life without those things. There are certain things necessary for society to function. Health care is not only moral obligation but one of those thing necessary for society to function.

RIT... I MUST have a roof or I will get wet. I MUST have walls or I will get cold. Is it my RIGHT to require that a roofer fix my roof or a carpenter build my walls?

Dadnatron · Nov 9, 2017

PILOON said:
While on the topic of prevention---
under the Canadian health care system tomorrow (here in Quebec) we get our FREE* flu shots.
The 'ounce of prevention is worth a pound of cure' adage applies.

They do free flu shots but we have to pay for shingle shots.

* free fo very young or seniors and those that are primary care keepers for elderly. (balance pay)

Do you really believe they are 'FREE' ?!?! You do pay taxes do you not????

Travelover · Nov 9, 2017

Dadnatron said:
The way insurance currently works... the nuts and bolts... is why health care is so expensive. NOT the doctors... but the system. .........

You are obviously quite knowledgeable about the system, being in the thick of it. If you had a magic wand, what would you do to change it?

buckeyefarmer · Nov 9, 2017

Get the insurance companies out of running healthcare, and make them just be insurance. Congress can do that, but they won't.

Dadnatron · Nov 9, 2017

Travelover said:
You are obviously quite knowledgeable about the system, being in the thick of it. If you had a magic wand, what would you do to change it?

1st: It would be difficult, but I would make insurance work like it worked 40years ago. Patient's pay their bill at the time of service and insurance reimburses the cost directly to them.

This would IMMEDIATELY bring down the cost of medicine in all instances, because people
1. Would shop around rather than just 'go where they were told'.
2. Make better decisions on how THEY care for themselves, because they would be on the hook for costs, even if for only a little while.
3. Take the 10% high cost gravy, which is the main contributor to increasing costs, away from the Insurance companies as THE driving force for costs. Insurances LOVE it when it costs them $1B rather than $1M because their % is bigger.
4. Get rid of the waste in medical care such as the lavish... and I do mean LAVISH entries with koi ponds and fountains, in the new hospitals. People wouldn't be willing to pay 'extra' to have their wheelchair rolled across imported marble floors.

2nd: I would completely revamp liability. Lawsuits can be good, when truly holding a physician/medical person accountable. But that isn't how it works. Suits are filed in order to reach a quick settlement which is MUCH LESS EXPENSIVE than the costs of fighting the suit. Their definitely needs to be lawsuits, but they need to pass muster via a panel of KNOWLEDGEABLE people, before they EVER get to the true 'case' stage.

3rd: I would get .gov out of MOST healthcare. They are another reason for the incredible mess we are in. If you want to think about how Universal Healthcare ran by the government would look... Look no further than the VA system. It mimics a lot of what is typical in both Canada and the UK.

But... if I could fix just one... I would change how insurance works. Without removing the middle man who is in charge of everything... none of the other things will make much difference.