primitives know why we have health care prices we have

[franksolich]

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6006979

Oh my.

If people were actually what they believed they were, Skins's island would be teeming with Albert Einsteins.

dixiegrrrrl  (1000+ posts)      Tue Jul-07-09 02:05 PM
Original message
 
you want to know why we have the health cost problems we have? 

I'll lay it out for you - in a way you can't refute or argue with:

1. There are no published prices. In no other line of work is it legal to do this. Nowhere.

You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws for "major" consumer work (e.g. contracting, auto repair, etc) where they must give you a binding written estimate before beginning work!

.......Whether you are paying privately, you have private insurance or you're a Medicare patient if you need to have a breast reconstructed due to cancer the complexity of the procedure does not change.

Yet it is a fact that the privately-billed amounts for uninsured ("rack rate") patients are often ten times or more that billed to insurers or Medicare. Try charging a cash purchaser 10x more for a TV than someone who finances that TV on your in-house credit facility and you would be shut down and thrown in jail.

To put this bluntly the medical industry has intentionally put forward a system by which it can screw you with impunity, obtaining exemptions from the laws that cover every other area of commerce, thereby effectively forcing you to buy overpriced services you do not want to purchase lest an unexpected life event literally wipe you out.

This is an extortion racket and absolutely none of the proposals being put forward have done a thing to address any of it.

Today's rant from Market Ticker.

http://market-ticker.denninger.net/archives/P1.html

lapfog_1  (1000+ posts)        Tue Jul-07-09 02:14 PM
Response to Original message
 
1. There is another industry where they try the same bullshit...

car repair.

Ms. Toad  (1000+ posts)      Tue Jul-07-09 02:46 PM
Response to Original message
 
3. What fantasy world are you living in?

Most of the examples you gave do not provide you with a fixed cost up front - generally they give you a non-binding estimate based on assumptions about what will be found once the work is started. I am not aware of any "major" consumer work where a binding estimate is legally required. You can certainly attempt to write a contract that creates a binding estimate - but (1) you may not get one and (2) it may be higher than it otherwise might be because the contractor must cover some contingencies that might not occur.

Medicine is as much an art as it is a science. Although you might be able to fix costs for some procedures, some procedures are unpredictable in advance - and what procedures are necessary are also often unpredictable.

No - I am not in the medical industry (but I am well aware how uncertain it is) and yes, I am in one of those other fields you incorrectly suggest it is illegal not to provide the price in advance (and no I cannot and do not guarantee the price in advance).

dixiegrrrrl  (1000+ posts)      Tue Jul-07-09 03:57 PM
Response to Reply #3

4. the post is quoted from the Deninnger column to which I linked.

go argue with him.

[JohnnyReb]

I'll lay it out for you - in a way you can't refute or argue with:.....can't argue or refute 'stupid'.

1. There are no published prices. In no other line of work is it legal to do this. Nowhere. ...hmmm...crooked Chicago politics comes to mind.

Ooooops, missed that word, Legal.....but then maybe it's legal in Chicago.

[Chris_]

That's one of the stupidest DUmmie posts I've ever read....

[Karin]

Stupidest post of the day, to end my day.  C-ya tomorrow!

[Freeper]

well in no other industry are prices raised to pay for those who can't pay. You don't pay and extra $20 for a tv so an illegal alien can get one for free. 

[SSG Snuggle Bunny]

Personally I think insurance inflates prices. If an HMO says it will pay X-amount for Y-procedure you better believe Y-procedure is going to cost X-amount every @#$%ing time and not one dime less. The patient (read: consumer) has no reason to seek lower costs and the provider would be an idiot to offer X - 10% if the competitor gets the full X (competitor gets more net $$$ to compete).

Am I too crazy?

[jukin]

I was going to say all the moochers and illegals not paying.  Why else would a "not for profit" hospital charge $65 per Tylenol?

[Freeper]

I was going to say all the moochers and illegals not paying.  Why else would a "not for profit" hospital charge $65 per Tylenol?

The Tylenol they gave me had little gold flakes on the capsule. 

[Tantal]

Personally I think insurance inflates prices. If an HMO says it will pay X-amount for Y-procedure you better believe Y-procedure is going to cost X-amount every @#$%ing time and not one dime less. The patient (read: consumer) has no reason to seek lower costs and the provider would be an idiot to offer X - 10% if the competitor gets the full X (competitor gets more net $$$ to compete).

Am I too crazy?

No, but I also think the DUmmie has a point. I'd like to see a price list on the wall of the doctor's office or at least on their website. If McDonald's and Jiffy Lube can figure out how to do it, I'm sure a medical practice can. Something along the lines of:

Basic Visit: $249.99
Blood Draw for Labs: $69.99
X-Rays: $24.99/each

It's hard to shop around for the best price when nobody will tell you what the price is. I'm a pure capitalist, which means that I think that the consumer should have all of the information available to ensure that they get the best product at the best price they possibly can.

[The Village Idiot]

Mandates. Regulation. Law suits. Medicare and Medicaid.

Those are the reasons.

[MrsSmith]

well in no other industry are prices raised to pay for those who can't pay. You don't pay and extra $20 for a tv so an illegal alien can get one for free. 

Every industry raises prices to cover the losses they suffer for those that can't pay, and to cover expenses like taxes.  The only ones that don't are those that are at the mercy of the market, like farming, ranching, dairying, etc.

[MrsSmith]

And, BTW, the newest thing in ERs is to lay out the probable cost beforehand and get a payment agreement signed before treating minor problems and injuries.  I'm betting no one will be terribly happy with that, either.

[thundley4]

And, BTW, the newest thing in ERs is to lay out the probable cost beforehand and get a payment agreement signed before treating minor problems and injuries.  I'm betting no one will be terribly happy with that, either.

I dunno. Some might like that , especially if we can see the probable cost and then tell them we have insurance.

[Celtic Rose]

No, but I also think the DUmmie has a point. I'd like to see a price list on the wall of the doctor's office or at least on their website. If McDonald's and Jiffy Lube can figure out how to do it, I'm sure a medical practice can. Something along the lines of:

Basic Visit: $249.99
Blood Draw for Labs: $69.99
X-Rays: $24.99/each

It's hard to shop around for the best price when nobody will tell you what the price is. I'm a pure capitalist, which means that I think that the consumer should have all of the information available to ensure that they get the best product at the best price they possibly can.

Agreed.  Of course, with more complicated procedures the prices would have to be more flexible, because there is always some unpredictability and possible complications, but I would think an estimate would be possible.

[MrsSmith]

I dunno. Some might like that , especially if we can see the probable cost and then tell them we have insurance.

Maybe.  The majority of those that are asked to sign payment agreements don't have insurance, or have poor insurance.  If they were insured, or even if they intended to pay the bill, they'd be at a doctor's office.  Because they are using the ER for more-or-less routine care, they are asked to actually pay the bill.  I'll bet not one DUmmie would like it...   

[BadCat]

Medical costs are high primarily because of "administrative" overhead.

I've told this story before, but it demonstrates the point...

When I got my vasectomy, my insurance paid for it, but I got a copy of the bill.  There were two TINY incisions, requiring one stitch each.  On the bill was...

Neosporin - $25.

Now, you can buy a boatload of Neosporin for $25, so I asked my buddy who was an admin at the hospital why the tiny dabs of Neosporin cost $25.

This is why...

When they open a tube, they cannot use it on another patient.  Anything not used out of that tube must be discarded.

They have to keep track of that tube of Neosporin, from purchase, to storage, to use, to disposal.  Big paper trails.

When you have that type of waste coupled with that type of bureaucracy, costs are going to be high.

[MrsSmith]

Medical costs are high primarily because of "administrative" overhead.

I've told this story before, but it demonstrates the point...

When I got my vasectomy, my insurance paid for it, but I got a copy of the bill.  There were two TINY incisions, requiring one stitch each.  On the bill was...

Neosporin - $25.

Now, you can buy a boatload of Neosporin for $25, so I asked my buddy who was an admin at the hospital why the tiny dabs of Neosporin cost $25.

This is why...

When they open a tube, they cannot use it on another patient.  Anything not used out of that tube must be discarded.

They have to keep track of that tube of Neosporin, from purchase, to storage, to use, to disposal.  Big paper trails.

When you have that type of waste coupled with that type of bureaucracy, costs are going to be high.

If you think that waste was expensive, imagine the costs to the hospital if the tube was reused...and the next guy got something like Hep C.  $25 (after mark-up) of Neosporin compared to $25,000,000 legal costs and settlement.

[thundley4]

If you think that waste was expensive, imagine the costs to the hospital if the tube was reused...and the next guy got something like Hep C.  $25 (after mark-up) of Neosporin compared to $25,000,000 legal costs and settlement.

But couldn't they at least give the tube to the patient?  What about the high charges for a band-aid or for a couple of aspirin?

[MrsSmith]

But couldn't they at least give the tube to the patient?  What about the high charges for a band-aid or for a couple of aspirin?

Oh, yes...they should definitely give the tube to the patient!  My guess (and it's just a guess) is that this wasn't an actual tube, it was a little packet of Neosporin, kind of like a ketchup packet...tear it open, use it once, toss it.

As for the high charges, every item is 1)received 2)stocked in Central Stores 3) ordered by separate departments - like Surgery 4) stocked in Surgery 5) recorded on the patient's record 6) charged to the patient 7) reordered for the department 8)reordered for Central...etc.

In our hospital, we've introduced little handheld scanners - somewhat like an inventory scanner.  These required 1)a wireless network 2) the scanners 3) the chargers 4) education -and repeat education and repeat education 5) frequent repair.  The nurses use these expensive little devices to scan their own badge, the patient's wristband, and the medication (or whatever item is being used), both to make sure charges are correct and to make sure the patient is receiving the correct dosage of the correct medication - and that dosage is correctly logged in his chart.  Obviously, it's already costing a ton of money to provide ANYTHING!

Now, add to that expense the locked cabinets in which most charged items are kept - to reduce theft.  These are all computer based, nurses must log in and scan every item they remove. Pharmacy and Central Stores inventory every cabinet in every department at minimum daily, and restock all needed items.  And, of course, more expense is added at every level from device purchase to device installation to training to personnel.

Now, add the fact that some items must be refrigerated...and purchase, install, educate, stock, maintain locked refrigeration units in every department.

The expenses are massive...and all that is added to every patient bill.

If it makes you feel any better, by the time this all hits the bottom line, a healthcare facility that clears 6% in a year is doing fantastic.  This year, every one I know of is in the red.  Salaries are frozen, overtime pay is frowned upon, agency nurses are not hired unless we're desperate, and nurses are being applauded for finding ways to save $5 on anything.

[AllosaursRus]

It's the same in every business. My Doc DOES have a price list! Perhaps many don't but the fact remains, as others have stated, those that pay, make up for those that don't.

A good example is shoplifting bringing the price of goods up in every commercial enterprise.

Which BTW is EXACTLY what the Goons at DUmmieLand want! They basically want to shoplift their healthcare!

edited to add content

[USA4ME]

No, but I also think the DUmmie has a point. I'd like to see a price list on the wall of the doctor's office or at least on their website. If McDonald's and Jiffy Lube can figure out how to do it, I'm sure a medical practice can. Something along the lines of:

Basic Visit: $249.99
Blood Draw for Labs: $69.99
X-Rays: $24.99/each

It's hard to shop around for the best price when nobody will tell you what the price is. I'm a pure capitalist, which means that I think that the consumer should have all of the information available to ensure that they get the best product at the best price they possibly can.

They do to some degree.  This isn't a perfect exmple, but I have my health insurance through Blus Cross/Blue Shield of NC and it's a PPO.  Of course with a PPO, the insurance company has negotiated with the healthcare provider to pay $X for a certain procedure.  For instance, I go see my GP for a sore throat, it cost me $25.  Maybe it should have only cost $20, but next time maybe it should have cost $30, so I think it all evens out.  If you have a similar plan, you can contact your provider and ask for their price sheet.

Otherwise, I'm betting if you ask the doctor to give you round estimates of what you can expect, his/her ofice manager could provide that for you.  I doubt many doctors are going to post prices on the wall or anything.  I mean, there is a level of professionalism in a doctor's office where you don't want to look like a JiffyLube.  But they could have a price sheet they hand out where they give estimates based upon past experiences, I could see that being a nice service.  As long as they presented where people couldn't hold them to that price because, as was mentioned, every individual situation is different.

.