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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
Yes. But, rather than symptomatic I prefer emblematic. It is a way for all of us to monitor the damage and distortion that the government has done to this field.
It is interesting that these numbers are put in the invoicing — this is the way these companies talk to us rather than wading into the details of how ridiculous this all is. This invoicing approach is a little bit of rebelliousness.
I think it’s time to fix this — I hope that we will see this fixed in some meaningful way in the next few years.
Thanks, Bob — and thank you for your contributions here. This IS an important topic and this copy of a recent invoice is one of the best ways of explaining and talking about the real crux of our problems.
Also, note my mention of my Swedish brother-in-law. He is convinced that all important things should be given over to the government. This is where we traditional American fundamentally part company with Europeans.
It’s even messier than that. One of the common adverse drug effects of the bisphosphonates commonly used for osteoporosis is GERD. PPIs are commonly prescribed for this. In addition to the problems you mentioned, they interfere with calcium and other essential mineral absorption… and they interfere with the action of the bisphosphonates as well.
I just showed this article to a well-informed conservative friend here at work and he immediately placed the blame on the insurance companies. I note that others here also place the blame (or most of it) with these companies. I was able to get my friend on my side when I asked the simple question: who is MORE to blame here — the government or the insurance companies? He had to put the blame where it really is and said: the government. And then he disparaged the insurance companies for taking advantage of us all through use of the government. I agreed that that is a bad thing but crooks will always take advantage of stupid things that government does.
Netscape tried to use the government to go after Microsoft years ago and Microsoft went from having very few (if any) lobbyists in D.C. to one of the bigger users of lobbyists. This is all just simple self defense. Healthcare and insurance companies are rich enough to employ the best lobbyists and work things out for their benefit but not necessarily for ours. This is natural and it is why we need to stop the growth of government and stop the bullying from the ruling class.
Healthcare itself is way too important to be given over to the government. The path to better healthcare is like a puzzle with many pieces. This third party payment mechanism is one, and maybe the biggest, in terms of wasted resources. There are issues involved in the processes related to how one enters the field of practicing medicine, getting into medical school and financing that process. I just described in an earlier comment a choice to be made individually to take medicine or change behavior to deal with a medical condition. I can remember as a young man I was discouraged from eating eggs and consuming butter or whole milk. The nutritionists turn on a dime. I really enjoy these products now including at least a dozen eggs weekly. There are so many pieces to this puzzle. One thing that I can’t tolerate and may be the death of me yet is government mandates in this field.
Yes, agreed: laws by government are very blunt tools and often do more harm than good.
“First do no harm.” <– Applies to government every bit as much as medicine.
Me, too. We all agree this sucks.
But none of us are movers and shakers.
Let’s not forget the plaintiff’s bar. I once saw a young man who had been in the back seat of his girlfriend’s car in a residential neighborhood when it was broadsided by a drunk doing about 50.
One ear was slightly avulsed, but they tacked it back down. Needless to say, “My neck is really stiff.” Then, when his neck got less stiff, “I was in the shower this morning and I bent my head forward and there was this sort of electric shock feeling all the way to my fingers, see, if I do this it happens again.”
“OK, thanks, don’t need to do that again, do you mind sitting quietly in the waiting room, here, wear this collar to remind you not to move your head again.”
Call my favorite neurologist. Describe the situation. “Send him right over.”
The MRI showed a 1cm bruise deep in the spinal cord right at the base of the skull. Prognosis: “Might get better. Might not, in which case the result is likely to be syringomyelia (a cyst that can destroy the spinal cord.)”
Fast forward a year and a half. Bruise is gone, no neurological problems.
Phone rings. “Hi, doctor, this is Sandy Cheatem, Mr Smith’s attorney?”
“Yes?”
“His case has settled, and there wasn’t nearly as much money in it as we thought. Would you mind reducing your bill?
“No, my bill is reasonable. Thank G-d he got better.”
Long silence. “Oh. Right.”
I bet there is some legal requirement for them to show the health care consumer these numbers.
I blame the people. We did it to ourselves.
Yes, we share the blame with the people who actually carry out the evil. But, we are not the proximate cause nor are we mostly to blame. We are not the government and the government can do bad things that we don’t endorse and we are now living through a time when the people are roused up to fix the problems that several decades of bad ideas in government have been experimented with and found wanting.
One of the things I find so ironic in this discussion is that while fertility medicine is often considered the most morally questionable, in terms of its billing, it is far and away the most ethical.
Almost no insurance covers fertility treatments (and those like mine that do have rather low lifetime caps). So after I had my first appointment with my fertility doc, she sent in a representative from the billing department with a lovely itemized price list for services.
IUI? That’ll be $187 for a transvaginal ultrasound, $300 for a sperm collection and wash, and $300 for a sperm deposit. Exactly the kind of straightforward honest billing that we want for everything.
Haha, you might be behind the times. I have heard that windshields are often replaces on deductible from incidental insurance. Also, we now have huge extended warranties and care packages that give you your regular maintenance for free at the dealer ship. The only difference is that there is pricing transparency.
Think extended warranties on computers, dryers, etc: You lose money. The dealer makes money.
I am aware of this. But a windsheild isn’t something that always has to be replaced, is it? Thinking back over all of the cars I’ve ever owned, only two of them required a windshield replacement, and in those cases, only once each.
As far as the extended warranty, well, that isn’t insurance. It’s a payment plan.
In the main, most people insure their cars for things they don’t think are ever going to happen. Or at least, they think those things are very unlikely. Which is why auto insurance works and is affordable.
I disagree most vociferously. We are entirely to blame. We do not want to pay for our own health care. We simply don’t. We want someone else to pay for it. We do not understand how insurance works, which is why we want it to pay for every last thing we think we need.
The root cause of the problem is people not wanting to foot their own bill, to treat health care like a the financial transaction it is.
The fact remains that you don’t get where we are without the government as the vehicle for this chosen ignorance to ride. Education is there as well. Bernie Sanders makes it sound as if one arrives in this world and everything is supposed to be free, as if no one pays. And one does not need to be a libertarian to see this approach as theft.
I’m not saying that isn’t true. I’m just saying that we let….no we asked the government to do this. Maybe not you and I. The general we.
Yes, that’s definitely what this disagreement is about, not insurance, but under what terms and to what extent should people go about helping one another and at what level of interaction should this happen. Oh, and you are right that none of this has been about ‘insurance’, the word is misused here. Should say healthcare socialization, not healthcare insurance.
As a physician I can shed some light on those claims. The top number usually relates to what the “best” insurance payors will reimburse for that code. The hospital is not going to leave money on the table and if one group will pay that much for a service that’s going to be the price. The discount then is whatever they’ve negotiated with different payors, in this case Blue Cross/Shield. The real crime is the medicare and medicaid pricing and undercutting of physician practice/patient health. As long as someone else is paying for your health care you will be a third party to the transaction and have little say over how the process happens.
I have mentioned it before, but it bears repeating. I see two solutions for this. First, we could treat hospitals the way we treat common carriers, and require them to charge everyone the same amount for the same services. This would make pricing transparent and predictable, and would allow patients to shop around.
Second, we could allow people to join health care co-ops, which would not pay for medical expenses like an insurance company, but rather would just negotiate discounted prices for their members. Right now people are basically forced into health insurance programs, because if they don’t have insurance the hospital will bill them $40 for an aspirin. If I could be part of an organization that would negotiate the same prices for me that the insurance companies get, I would much prefer to pay out of pocket for everyday medical expenses, and insure only for catastrophic medical events.
Spin is right.
Chronic disease is a bigger and bigger part of healthcare. To a large extent, it is “lifestyle” driven: caused by excessive and excessively frequent consumption of calories, underconsumption of essential nutrients, and a movement deficit. Prescription drugs are not the key to this; they would be, if all were well with the world, down at plan B or C.
Eating less, eating (except as a needed tactic) less frequently, making better food choices, and exercise will all, if done properly, either fix or greatly change the disease course in most cases. But, as one of my teachers said, this is not a spectator sport.
It’s not a sexy one, either. You’d never have Grey’s Anatomy, or General Hospital, or any of the other opinion makers that tell you that surgery and miracle drugs will fix anything and unconsciously create patient expectations.
Sometimes they do. Heck, sometimes a patient comes to a chiropractor for the second visit and says “Hey, doc, my blood pressure has been completely normal since that adjustment.” It’s not the way to bet, but it happens.
But in the trenches, patient participation, and patient compliance is key. Medicare and medicaid (under)pay for procedures.
I take back everything I’ve said about you. Well, not everything…
What’s funny is that if you go to the vets at PetSmart, that is exactly what they will sell you. $15/mo/pet to get “free” annual exam, shots, and a 15+% discount on all other services.
Yeah, because then you wouldn’t be right anymore.
I really believe that “free market conservatives” don’t give this type of idea the credit it deserves. Do you get to shop around for an emergency care hospital when you are unconscious from a car accident? So, how again is that a free market situation at all. Yes, treating hospitals as common carriers would not be free, but they aren’t anyways. Arguably, they would be more free since people could look into their local hospitals and keep a little card in their wallet saying which hospitals they prefer.
And, idea 2 is even better. No one complains when people shop wholesale/big stores (costco is even membership only). That is a similar idea, no? As Larry said, he would rather pay out of pocket if he could get the prices negotiated to be reasonable. That would be a freer market and would contain insurance to what it is supposed to be for, catastrophic expenses, rather than being payment plans.
During Health Care Debate 1.0 during the Clinton years, if you analyzed what people said in surveys, their response could be boiled down to:
” I want the best healthcare someone else’s money can buy”
Hasn’t changed.
Well for real emergencies that could be problematic as well. Hospitals do not have interchangeable resources or skills. Where I would prefer one hospital to treat my Myocardial Infarction, they may not be a Trauma Center. Proximity at time of emergency is critical too.
Let’s establish clearly what you are saying. Is the government as a separate entity not to blame for anything? There’s no point in arguing about where to lay blame if you are opposed to blaming the government for anything. And if the government has some blame we need to then sort out how much is apportioned. Let’s save some time here and flesh this weird idea out.