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Health Care Discussion – Why Does No One Discuss This?
What is this? What is this all about? What other business is run this way?
I say again: What kind of business is this?
Isn’t this a symptom of something that is severely distorted? Isn’t that first number a cry for help when viewed in context with the adjustment? That first number is a fake number.
Here’s what’s going on — the government has stepped into this field in a big way and it has caused an intelligent and clever response from the business people in the medical industry. This creative invoicing method is done in concert with the insurance industry people. Government people know that the top “price” is a scam number and they don’t talk about it. None of us talk about. I want to know why this issue isn’t discussed and why it isn’t used as a method of measuring (at least indicating) the level of damage that government regulations do to a critical industry — and the medical industry is important to each one of us.
As I tell my Swedish brother-in-law doctor: “The medical industry is too important to let the government control it.” This causes him to visibly blanch because it turns his world view upside down.
(Thanks to @davecarter and @docjay for the excellent Radio Deplorable podcast at http://ricochet.com/podcast/evening-doc-jay/. I was going to put this in a comment there but decided to write a post instead. I hope you all can give Dave’s episodes a listen.)
Published in Healthcare
Many here don’t remember when things were really different in the medical treatment area. I married in 1966 and our first child was born in 1967. I had been single and working for some years without any doctor visits. My wife and her family had an MD, he was a GP but did care for my wife through all three pregnancies and deliveries. His fee for the prenatal care through delivery was $150. The hospital fees were $600 which covered normal delivery and care. When we had to take one of the children or one of us in for a checkup or an illness, the office visit initially was $3 and the doctor expressed regret when he said he had to raise it to $5. One thing that kept this charge low was that he did not operate by appointment but rather ran his office more like an ER for all, so the waiting area was always crowded and the wait could be long. Also, if you were with a fever or an injury or in serious pain, he had another waiting area where your treatment could be expedited. We paid his fee for the prenatal and delivery over the period of pregnancy and the hospital on time payments as well. He was our family physician for more than a decade and then things began to change. By then Medicare was really starting to kick in. We had group hospitalization, didn’t use it much, filed our own claims.
Non responsive.
And the government’s role in this debacle?
Also, weren’t HMOs a response to the government regulations.
I don’t know what that means…
This is a fair point, but the counter point is this: if my daughter had been born in 1967, she’d have died within 48 hours. Your doctor wouldn’t have know what to do, probably wouldn’t have known there was a problem until she went in to adrenal shock.
As it stands, she was diagnosed with a rare genetic disorder within hours. Tests were ran, the results were conclusive, and she was at Children’s Hospital in Seattle 24 hours after she was delivered.
So yes, things were really different…
True. What you point out is essentially the technology component that has been a contributor to increasing the cost of healthcare. It gets mixed in with all the other additional costs related to the administration of the socialized medicine process and also mixed in, of course, is very likely unjustifiable profitability in some sectors that gets obscured with no competition.
There’s also the large default rate on medical billing, that is factored into the initial prices.
I used to process health insurance claims in a previous life. These were Medicare claims, and we were paying the patient portion (the part Medicare didn’t cover). Obviously these claims were for senior citizens, and most of the time they were fairly significant procedures. I remember seeing bypass surgeries, organ removals, things like that. We’d see the total the provider billed, along with the Medicare allowable (what Medicare thought it should cost), and what they then would pay, leaving our company with the balance.
The company I worked for at the time would design Medicare Supplement plans that Hospitals could sell to seniors in their area. The problem in those days was that, because the population in the midwest was aging, hospitals were losing money because their primary customers were medicare patients. And they could not recoup their costs. So the solution was to own the insurance policy as well. I should say, it was a solution.
Anyway, it was common knowledge that the hospitals would pad their charges. They had to. So they’d artificially increase the prices to try and “game the system” if you will: to get medicare to pay more. Subscribers (patients) didn’t care so long as they weren’t left holding the bag.
Right, this all comes down to the third party payment problem and lack of transparency in prices. This problem goes back to WW2 and the advent of employer sponsored and tax code subsidized insurance.
That’s right.
Everyone knows the time to make deals on Oracle Licensing is right before their fiscal year end (Quarter end is good, Year end is better), when the sales guys are trying to make their numbers.
With Microsoft its right after they change their licensing schema when all their sales people are confused as hell.
This is off-topic, but my experience with Microsoft is there pricing model is pretty stable. I have never seen big 80% discounts in volume license pricing. But I’m not buying 10,000 seats, either. Oracle, SAP, and other vendors I’ve seen generally do that big discount to make you think you are getting a deal. Cisco and EMC are that way, too.
Microsoft doesn’t do discounts but you can slip things by confused salespeople.
I’ve always said, the real problem with how we pay for health care (which is what we mean when we say “health care”), is that the person consuming it, doesn’t pay for it. That is the root of the issue. It’s not the only issue, but it is at the root.
I think we should insure our our bodies the way we insure our cars. We don’t insure our cars for the stuff we know will happen to everyone. My auto insurance doesn’t pay for my tires, or my brakes, or my oil changes. They don’t pay for new shocks, nor to fix the ding in the door. They did pay when that gal backed in to me. And when I hit a deer a couple of years ago. We seem to generally understand that this is the right way to do it.
However, when it comes to our health care, we just want it all paid for.
The do discounts. They just aren’t giant. As I sit here and think about it, I think that the closer a company is to the consumer, the more realistic their pricing model is.
I don’t buy in enough volume to get discounts then :(…
Exactly right, also by not insuring everyone for foreseeable expenses it puts the onus back on the consumer to live a healthier life to reduce costs. I know I take better care of my 1974 Alfa Romeo than I do my 2011 sedan with bumper to bumper maintenance.
This was also when chiroquacktors were jailed. I miss those days.
Of course, the Alfa probably requires it, where the new car does not.
Hey, the parts falling of that car are the finest in Italian craftsmanship.
My grandfather, A”H delivered thousands of babies. My mother remembers driving through the neighborhood near his office, and hearing the comments made about the children on the street: “That one’s paid for, that one’s not paid for…”
Your elderly Alfa also needs a lot more maintenance to stay running and on the road without parts falling off.
Your 2011 sedan could probably do 100,000 miles with the hood welded shut. Not saying it’s optimal, but I doubt the Alfa could have done its first 100,000 that way at all. Unfortunately, as far as chronic disease is going, the human models recently on the road are more likely to have them earlier in life.
I want to thank Larry Koler for posting and asking an important question. We’ve ranged beyond the specifics of the question he asked and I’m going to do that again. Hope you don’t mind, Larry.
@spin raised the issue of technology which represents a portion of increasing costs for better healthcare outcomes. I can testify to that. I was questioned by the US Navy physician when I entered NROTC for a heart murmur. The murmur was determined to be what they called IIRC non-functional and would not impair my performance as a naval officer. After I was in retirement and in my sixties, a more detailed exam said I had aortic stenosis, a common occurrence when one has a bicuspid aortic heart value, a congenital abnormality, the normal being tricuspid. At 68 years old, while walking, I had extreme shortness of breath of a form never before experienced, and a few weeks later had open heart surgery to replace the valve with a bovine valve from Edwards Life Sciences. That’s ten years ago and I just finished my 5 mile walk today. If I had been born 50 years earlier this would not have been available and my life expectancy at the point I had surgery would have been 1 to 2 years.
As I noted in my last comment, I just got through my five mile walk and that gave me time to consider our approach to healthcare, cost, of course, being a big issue along with who pays. I had some experiences recently that got me back into my exercise and diet regimen in a serious way.
I get something called atypical GERD (reflux) so my doctor gave me a prescription for a PPI. My prescription medication is covered through a contract my insurance carrier has with a pharmacy. When I went to pick it up, that particular pharmacy branch had not updated my insurance record for the new year, so when I started to pay for a month’s supply of Omeprazole capsules 40mg, the charge was $300. I got it corrected and my co-pay was $10.
Since my insurance has a contract I’m sure they don’t pay the difference of $290. And I know that this drug in tablet form over the counter for a month’s supply may run $30 to $50, perhaps a slightly less effective formulation. So maybe a charge for the drug I got that includes profit for the pharmacy would be legitimate at $100. I’m just making a layman’s guess, we may have people here who can comment with better knowledge. It just seems like, to Larry’s point, the numbers don’t make a lot of sense up front, so it’s worth talking about.
After I got that prescription for 40mg Opmeprazole capsules to treat my reflux, I began taking one every morning and within 2 weeks it seemed to be working. I continued taking it and after a couple of more weeks the effectiveness seemed to be disappearing. Since I had this same condition almost a decade ago and got rid of it by reducing the weight around my middle, I decided to drop the use of the PPI and change my diet (no sweets and no starches with some reduced volume of other foods). That was a little over 2 weeks ago and my reflux is gone. I have probably dropped somewhere between 5 and 10 pounds, all in the middle. After I stopped the PPI, I also read a current article suggesting there are some fairly serious common side effects on kidney and intestinal functions, so I’m happy to be not using it. More health related information is good.
Back to the original question – why does no one talk about this?
1. It’s too confusing.
2. Most don’t care.
3. To whom would we discuss it?
On that last point, I see my Representative (if you can call her that) about once a year. Do you know how many seconds it would take for her eyes to glaze over? And as for writing anything more than vote yes or vote no, or maybe if I choose to go polysyllabic “please support x” or “please oppose y”, who is going to read and think about it? Dan Patrick (TX) used to read and respond thoughtfully but I bet no longer.
Do I sound cynical? Well, when “repeal” somehow morphed into “repeal and replace” and finally into revise, that contributed to it.
For my part, I think a lot of people have talked about. I figure it is a symptom of the overall problem, not the problem itself.
I don’t know why the politicians don’t talk about it, but I certainly talk about it with family and friends.
So true!
In fact, the increased cost of medical procedures and equipment is used as the excuse for all of the problems.