Health Care

[Conway]

Opinion piece on why health care is so damned expensive, how our governments have continually made it worse, and how market principles could bring the prices back down to Earth. His style is a bit ranting but makes sense.

http://market-ticker.org/akcs-www?post=205591

Snippet below:

So what generated this "need" for health insurance? It's simply this -- if you don't have it you'll be bankrupted, but the reason you'll be bankrupted is that you will be charged 5, 10, even 100 times as much as someone who does have it -- all in a concerted attempt to force you to buy that insurance up front.

Oh, that's illegal too -- it's called a "tied sale" and any attempt to impose one is against anti-trust law. It's a per-se violation -- except in the medical industry, of course.

Proof that this is the case is found by the fact that you can get on a plane and fly to India to have a procedure performed at one tenth to one quarter of the cost in the US. But there is no "insurance" and no treatment without money. The hospital there is outfitted with US-supplied medical devices, the physicians were trained in our hospitals and the rooms look like something out of the Ritz Carlton and are priced more like them too -- instead of $10,000 a day.

[skipbeat]

Sounds like some mafia shit to me. Pay up or we'll ruin you.

is it true that in America you have to pay for EVERYTHING hospital-related? like, getting your arm in a cast, stitches, etc.. ?

[Conway]

Theoretically, yes.

[Mark E. Hurling]

Sounds like some mafia shit to me. Pay up or we'll ruin you.

is it true that in America you have to pay for EVERYTHING hospital-related? like, getting your arm in a cast, stitches, etc.. ?

Sort of. What happens for those of us with employer provided and personally paid for health insurance pay into the premium costs and the health care insurance company pays the hospital and/or physician. There things like deductibles and co-pays out pocket, and my explanation is a very simplified one because Dearly Beloved is the one who really understands the whole racket. Which is generally true in any household consisting of a woman who is really in charge. Which is the overwhelming majority of them.

[Conway]

Racket is an apt description.

[Jonathon Sullivan]

Nope. Give me a Scandinavian system any day, and twice on Sunday.

[John Bono]

The reason why medical care is so expensive in the states is that the people who receive care(patients) aren't the people who pay for it(employers, gov't). Because of that mismatch, no one who goes to a hospital actually gives a shit about how much things cost, and neither do doctors, nurses or hospitals for that matter. Therefore it's no shock that the cost of healthcare is so high.

For example, in Jan '11, I pulled my calf muscle, and I went to my PCP, and saw a physician's assistant, who was convinced I had a blood clot, said I had to go to the ER ASAP to check. I asked her if I could do this in the morning, to which she replied that it was absolutely imperative that I go immediately, that I could have a pulmonary embolism, etc, etc. I go to the ER, they put me on a bed, where I sit for about 3 hours. I knew at the time that the lab that checks this tends to run approximately on a 9-5 schedule, so I ask the nurse about 1.5 hrs in when I'm going to see a doc, etc. She says she'll get back to me. About 2.5 hrs in, the resident comes in, and tells me the lab is closed, and that I'll have to come back in the morning to have it checked. So this blood clot, which was so fucking important that I had to go to the ER right away, is now just kinda/sorta important, and I could go home and come back tomorrow. I was royally pissed. "You mean, I came down here, took up an ER bed for 3 hours, wasted my time, wasted your time, and wasted my insurance company's money for nothing?" At the time I was pissed off because of the complete waste that it had been. It may have only cost me $100 or so, but those three hours probably cost my insurance company a lot more. And given how much my normal medical costs are, I am enormously cognizant of cost, even if I don't pay for it, so when it is wasted like that, I get pissed.

[droidicus]

I had an interesting experience when I wanted to get a DEXA body composition scan. I looked all over for a place that would do it within a 100 mile radius. There were a bunch of hospitals that had a DEXA that was capable of doing a body comp scan, but NONE of them would let me pay for it myself (and my insurance wouldn't cover it since it wasn't medically necessary, not a problem, I was willing to pay for it). I finally found a hospital that would ALLOW me to pay for it myself, and they wanted $850 for the scan. I found places in other cities that would do it for as little as $75, so it would have been cheaper for me to take a day off work, fly across country, get the scan, and fly back then it would to go to a local facility during my lunch break!

I finally found a place that would do it for $100, but it was totally sketchy. They would only take cash, no checks, no credit cards, and you had to call the tech directly since the office they are connect with won't book the appointment. They didn't tell me the cash only part, so I showed up with only $75 in my wallet, and the tech said "egh, good enough" and took the $75 instead. So I got the scan and everyone was happy.

It took me 3 MONTHS to locate a place that I could get this 15 minute procedure done!

[DeeLee]

I thought the following article was interesting on why it is almost impossible for people with pre-existing conditions to get insurance at all. Basically, sick people have a good grasp of the actual costs of treatment, and thus are in a position to make informed cost-benefit analyses.

http://www.slate.com/articles/busine...ady_sick_.html

[Jonathon Sullivan]

no one who goes to a hospital actually gives a shit about how much things cost, and neither do doctors, nurses or hospitals for that matter.

This is completely untrue. Not only is it not true, I would argue that most hospitals (and even some doctors) are TOO concerned with how much things cost. Or rather, that most hospitals, many doctors, and the system as a whole is penny-wise and pound-foolish.

For example, in Jan '11, I pulled my calf muscle, and I went to my PCP, and saw a physician's assistant, who was convinced I had a blood clot, said I had to go to the ER ASAP to check. I asked her if I could do this in the morning, to which she replied that it was absolutely imperative that I go immediately, that I could have a pulmonary embolism, etc, etc. I go to the ER, they put me on a bed, where I sit for about 3 hours. I knew at the time that the lab that checks this tends to run approximately on a 9-5 schedule, so I ask the nurse about 1.5 hrs in when I'm going to see a doc, etc. She says she'll get back to me. About 2.5 hrs in, the resident comes in, and tells me the lab is closed, and that I'll have to come back in the morning to have it checked. So this blood clot, which was so fucking important that I had to go to the ER right away, is now just kinda/sorta important, and I could go home and come back tomorrow. I was royally pissed. "You mean, I came down here, took up an ER bed for 3 hours, wasted my time, wasted your time, and wasted my insurance company's money for nothing?" At the time I was pissed off because of the complete waste that it had been. It may have only cost me $100 or so, but those three hours probably cost my insurance company a lot more. And given how much my normal medical costs are, I am enormously cognizant of cost, even if I don't pay for it, so when it is wasted like that, I get pissed.

This is definitely bad care, John. It was bad from the git-go, and it was exemplary of many of the problems we have. However, this is only the tip of the iceberg.

The real problems with US health care are:

1. Too much health care money goes to people--mostly in the private sector--who don't do any health care.
2. Too much health care money goes to sick care--we screw the pooch up front on preventive medicine, holistic care, diet and exercise, and providing a basic care package for the indigent, and then bring up the big gun$ when those chickens come home to roost.
3. Too much health care money goes to death care. We admit patients who are clearly at the end of their lives to hospital beds and ICUs, to spend millions on them as they die, instead of giving them the compassionate and FAR less expensive palliative care they truly need. It's all part of this sick 20th century death rite; if you don't die on a vent with a bunch of tubes sticking out, then "everything wasn't done."
4. Too much health care money goes to patients who abuse the system: drunks, junkies, crackheads, hypochondriacs, etc. I'm going to get in trouble for saying this, but these people need to be tagged, tracked, warned, and ultimately lose their privileges and/or be institutionalized. Instead, we see and treat these people and put them back on the street and wait for them to come back. It would be cheaper to put them in sanitariums and mental hospitals.
5. Too much health care money goes to hospitals and emergency departments. This is stupid and unsustainable. My specialty has become, in some ways, the most important specialty in the house of American medicine. This is deeply, deeply fucked up.