HEALTHCARE: EVERYONE WHO LIVES IN THE USA *NEEDS* TO READ THIS!

Reading the article and I will only say this: I've never thought our healthcare system was right, but we're sure as hell not fixing it with whatever flaming snowball clusterfuck from hell they're trying to implement next year.

 

I'm frankly astounded that your healthcare system can be mangled to the point where it's essentially running like a private enterprise with people at the top taking home massive earnings while your patients are paying insane sums of money for treatment that should cost less. Moreover this really stuck out at me:

"Because Stephanie and her husband had recently started their own small
technology business, they were unable to buy comprehensive health
insurance. For $469 a month, or about 20% of their income, they had been
able to get only a policy that covered just $2,000 per day of any hospital
costs. “We don’t take that kind of discount insurance,” said the woman at
MD Anderson when Stephanie called to make an appointment for Sean."

You should never not be able to afford healthcare. Never. What would've happened if their mother had not been able to give them any money?

On top of that the guy was kept waiting because they had to see if the check had cleared! WTF? Unbelievable.

I really hope (almost certainly in vain) that this isn't an example of what usually goes on under your healthcare system.

EDIT: More thoughts. I do appreciate the focus on why the bills are so high as opposed to who should pay them. But it seems to me as though this could all be solved by the government putting its foot down and actually monitoring hospitals receiving money from the Medicare system. You know, calling out unnecessary markups, reducing the ridiculous salaries those in the upper levels (and even mid-levels if this article is to be believed) are paid at the patient's expense. Owait, I seem to be advocating a socialist healthcare system, at least in embryo. I'll just let myself out, since we all know what happens when you advocate anything being government-run and owned in the U.S. (although to be honest I somehow doubt even your government can be trusted to run anything without trying to make a profit )

I will say this though; if hospitals and treatment centers are still being allowed to generate profits, even when being subsidized by the government, even when supposedly being "non-profit", and the payout goes to the rich execs and managers far out of proportion to what they should be paid for their work, something has gone badly, badly wrong and it cannot be allowed to go unnoticed.

 

This is.... fairly fucking bad..

 

Thanks for the link to Bitter Pill Magnus. I distinctly remember listening to the article's lead writer on the Diane Rehm Show back in March (broadcast here), though never did find the issue of Time the article was supposed to be in during my visits to the library that month. I'll be sure to read through after work later today.

 

Reading this sure made me thankful to be Canadian.

Sure, our healthcare's far from perfect. But damn.

 

Doctors, especially family practitioners and non-specialists, have to jump through so many hoops and wait so long just to get paid by HMOs and insurance that many are actually quitting because they can't afford to keep their practice open and provide the level of care that they WANT to provide to their patients. It turns into a case of how many people can we stuff into the office in a day just to make ends meet as opposed to what can we do to make each patient better. Not to mention the outrageous cost of equipment and medicine. I was actually glad to see China cracking down on drug companies that were way overcharging for their products. Factor in ridiculous malpractice insurance fees as well since Americans feel it is their god-given right to sue anybody for anything.

I found this article a few months ago and while it's not a comprehensive solution it does make sense in many cases.

 

Having a doctor wife (ER doc) and myself working tangentially in healthcare (some IT consulting in the field), I can tell you its complicated beyond belief and the system we're in today is the results of decades of weird market incentives, constant negotiations between insurance companies, hospitals, and Medicare, and nobody actually having a freaking clue as to what the real COST of any procedure or process in the hospital is. Why? Because insurance companies reimburse by TRANSACTION, not by taking care of someone. Each item, drug, or minor procedure you do is a billable event. The insurance companies actually do not really pay anyone to take care of anything which has caused the billing system to became a competing set of 'codes' that the hospitals and insurance companies haggle over back and forth rather than any sane connection to cost. Hospitals have huuge charge rates as their standard because thats what they use as a basis of negotiation with the insurance companies, and the insurance companies haggle back and they settle on a number somewhere in the middle. Uninsured people don't get the haggling part, they just get screwed. Ironically, in the meantime, small doctor offices and primary care doctors are constantly getting squeezed because insurance companies and Medicare pay close to nothing for standard checkups and regular care... if a usual PCP takes more than 15 minutes per patient throughout the day, they have issues meeting their overhead, employee and insurance costs, let alone their salaries (which are quickly dropping). Specialist doctors make much more, and there is a shortage of PCPs around the country now as no one wants to get in that hamster wheel. There's been some pilots and movement from the insurance companies and hospitals to try to work together to figure out a more sane model, but its early stuff. Most of the pilots are going around episode based care (where you treat someone for an episode, like a broken leg, for example, and pay a lump sum for the entirety of care including the xrays, splints, follow up, drugs. It sets the onus on the docs to reduce their costs as they'll be able to pocket more of the fees.) or population management (where instead of per transaction payments you get a sum per member per year to handle basic needs for checkups and work ups). But its a slow moving industry.

Hospitals also overcharge the shit out of people without coverage as compared to those with coverage because the ones with coverage have the insurance companies haggling on their behalf, and as per US law no one can be turned away from the ER, lots of uninsured people use the ER as their primary doctor and the ones that aren't able to pay are covered by the people who can pay (and don't have insurance). Even with the 'overcharging', which only really affects the uninsured, and to some extent the private insurers (medicare/medicair pays lower than what they should in all honesty) hospitals are still closing around the country because of financial reasons. For example, two big hospitals in Brooklyn are closing in the next few months, there aren't enough hospitals int he area to support the population anymore, resulting already in 5-6 hour average wait times at the existing hospitals, obviously leading to issues and people not being seen in time. Additionally people wait for DAYS to get a bed in an inpatient department and just sit around the ER until something opens up, which further aggravates the wait times for other people. Its a fun system.

 

I would REALLY like to think that this kind of system would work on a large scale, and that we could work directly with healthcare providers. This would lower cost overall. However I do not believe that the capitalist mentality in the US would allow it work. People, especially the super rich, only want to make more money. If they can do that by squeezing it out of the little person, they will. Until the mentality in the US is changed so that people think of patients as people and not as ways for them to get rich, it will not change. For profit hospitals are by in large terrible when compared to non profit. I have seen this myself because the local hospital is For profit and hospitals within 1 to 2 hours are non profit, and the difference is staggering.

People will argue the point, but able to go to a hospital or a doctor and get medicine is a right, not a privilege. People should not have to choose either to put food on the table, or get the medicine they need to survive or at least to get better. However, in a lot of places that is where the US is right now.

 

The sentiment and thought is one of the biggest problems in this country. "Your way is wrong and should never be used, but I am not going to offer a solution." Sorry if I offend, but the same mentality is shared by many people in power in congress today.

What was originally desired was a single payer system, people screamed like bloody murder when it was proposed. So the system was whittled and beat and chipped until it passed. I am not saying a single payer system is the overall best system. but I think if you look at most first world nations in the world, they have a variation on single payer. They also have a much better and cheaper healthcare system then we have. I have not done all the research, but from conversations and the little I have read, this is the conclusion I have come to.

 

I think the first real clue about obama care, is that the people that passed it, are exempt from it. ><
Also the famous quote ""We are going to have to pass this bill so you can find out whats in it."" WTF!?!?

My insurance rates have already went up $118 dollars a month due to changes specified by the new rules and it is not even fully implemented yet. The small doctor owned urgent care clinic where my wife works, was just sold and the Doctors decided to retire instead of deal with all the new rules.

So I do agree that something needs to be done, but involving the government in anything rarely leads to reductions in cost or improvements in efficiency.

Also thanks for the article.

 

The pharmaceutical and medical technology companies argue that their high profit margins are necessary for R&D. There's a bit of truth in this, but still take this with a huge grain of salt.

There's no excuse for "non-profit" hospitals (that are tax-exempt for god's sake) to inflate the costs of goods and services to such an enormous degree (3x-10x the cost to the hospital, according to this article).

I've read through about half of this and will probably share it with the debate team I coach this Fall (these issues often come up as debate topics for high schoolers).

The bottom line is if you are uninsured and receiving medical care in the United States, you owe it to yourself to negotiate your bill and become educated on the true costs to the hospital, and their typical billing arrangements. If you know that they would typically make 50% of their stated bill, then you have a much better negotiating position.

It's bitterly disappointing to me that so much blood and spit has been wasted on debating changes to our medical insurance system (Obamacare, etc.) when what we really need are stricter controls on HOSPITAL profitability. We will have these for insurance companies in 2014, but while this may help consumers, it's nothing compared to the bills they receive from their care providers.

 

This. Its sad but true. If it wasn't for the fact Any sort of Med Schooling costs 120k+ by the time they are done. They wouldn't have to charge so much. INfact most offer free exams and xrays jsut to get people through the door. Less its to medicaid and medicare which do nto allow freebies of any sort.

 

I totally agree. I think that hospitals should not be allowed to be a for profit corporation that has stock holders or investors looking to turn a buck. They should be putting all of their profits back into the hospital and their employees to make it a better environment for doing what they are supposed to do. Agree 100% Magnus.

One of the problems with healthcare is there are dozens of moving parts and they all have to be addressed together to fix the issues. The hospitals are only one part of it, albeit a big part.

The Local hospital is a non profit and has been doing this for a while. They have recently set up a low income dentist services that they are funding, along with some grants. I believe they have other similar programs that they are working on as well. Now that does not mean they are not charging outrageous prices for other services. I am not sure how we fix that, I feel like a lot of it malpractice insurance and health insurance.

 

In the article it stated that many 'non-profit' hospitals actually have better numbers than profit ones, and the left over money is put back into the hospitals, which in turn increase the revenue the hospital needs for upkeep, which drives up prices.

In reality, if health care was efficiently run, hospitals would lose customers as many of them would be diverted to urgent care and other smaller facilities (like mini-outpatient procedure locations). Because the majority of a hospitals cost are fixed (as in you can't just get rid of floor space when no one shows up), it would cause major issues for hospitals. In countries with single payer the hospital inpatient capacity per person is much smaller, which is where they would be in the US if the market was efficient, but that would bankrupt a lot of hospitals and cause a lot of chaos and access issues until everything resolved itself. The whole industry needs changing, but its hard to do so without causing major disruptions to normal people getting access to care.

 

120k? lol... most of my wife's med school friends, who had to take out loans to pay for food and shelter during med school, have debt ~300k. If you managed to have money saved up or have someone else pay your rent, you're still looking at probably close to $200k in debt at graduation. Nobody wants to do primary care or peds where you make ~150k before insurance costs, which can be a 20-30k per year. Yes, its good money on 'average', but when you have huge student loan payments and could be making double that in a different specialty, why would anyone do it?

 

That was my biggest take-away from the article.

I don't think doctors are as much to blame as people seem to say, the problem is more with administrators and drug/equipment providers.

 

The average doctor is a horrible business person (thats what not they're trained for), and most of them have no idea what hte correlation of the procedures they do on prices, they just practice in a hospital, someone else figures out the bills later. That said, everyone has some responsibility, but its really hard to pin down on who really causes what.