A Hospital Bill Example: Ruptured Appendix Removal

[RadioCure]

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To start - Europe sees "stable" population growth because of the nearly 1:1 abortion to live birth ratio it enjoys.

I see what you did there.

 

[sustentacular]

I agree with your argument about healthcare; just because someone is sick or dying doesn't mean they are entitled to treatment.

Why not?

Couldn't you just as easily say something like:
Just because your house is on fire doesn't mean you're entitled to have the fire put out.
Just because you're being held up doesn't mean you're entitled to have the police come to your aid or investigate the incident after the fact.
Just because you're accused of a crime and can't afford an attorney doesn't mean you're entitled to a court appointed one.

 

[xanthomondo]

It amazes me that there are even pre-meds on here that aren't in favor of universal healthcare.

I'm glad you mentioned pre-meds specifically (even though you mentioned Doctors later in your post). I think you'll change your mind eventually.

I love seeing the patients who receive ~$1000 per month from the government to live and are still homeless. This guy ended up in a psych hospital but admitted that "I would rather get $1000 in PCP per month and be homeless." People abuse the hell out of the system and I don't feel like giving everyone a free ride.

There are systems in place for those who are hard working and try to succeed.. There are systems in place for those who are disabled and can't provide for themselves. I have no tolerance for the lazy drug addicts who want a free ride for their entire life.

As a doc I'm going to 1) have to make less money and 2) pay more in taxes so that these people "get what they deserve". Yet no one is helping me with my ~$300k in debt. Sounds fair to me!

 

[morning]

I have what I consider to be "good insurance" and here's a few estimates based on my insurance website's treatment cost estimator for "in network" facilities around Boston:

EMERGENCY CARE BY PHYSICIAN
Emergency department visit of moderate to severe complexity
Estimated Treatment Cost: $261-342
Plan Responsibility: $241-322
Member Responsibility: $20

HIGH COMPLEXITY EMERGENCY DEPT VISIT (PHYSICIAN COST ONLY)
Standard charge for emergency room visit of high degree of difficulty
Estimated Treatment Cost: $177-231
Plan Responsibility: $157-211
Member Responsibility: $20

EMERGENCY ROOM CHARGES FROM FACILITY
Standard charge for use of emergency room
Estimated Treatment Cost: $716-1,292
Plan Responsibility: $616-1,192
Member Responsibility: $100

LAPAROSCOPIC APPENDECTOMY
Estimated Treatment Cost: $9,573-13,463
Plan Responsibility: $9,493-13,383
Member Responsibility: $80

So depending on how I make my way to the ER to be sent for an appendectomy I might spend about $200

It wasn't just an appendectomy. This person had a RUPTURED APPENDIX and a long hospital stay.

Of course, if they had had insurance, it might not have gotten to that point.

I'm glad you mentioned pre-meds specifically (even though you mentioned Doctors later in your post). I think you'll change your mind eventually.

I love seeing the patients who receive ~$1000 per month from the government to live and are still homeless. This guy ended up in a psych hospital but admitted that "I would rather get $1000 in PCP per month and be homeless." People abuse the hell out of the system and I don't feel like giving everyone a free ride.

There are systems in place for those who are hard working and try to succeed.. There are systems in place for those who are disabled and can't provide for themselves. I have no tolerance for the lazy drug addicts who want a free ride for their entire life.

As a doc I'm going to 1) have to make less money and 2) pay more in taxes so that these people "get what they deserve". Yet no one is helping me with my ~$300k in debt. Sounds fair to me!

Wow, strawman much? There are people who lie on the FAFSA and get away with it, too. I'm sure we should take away Pell Grants, Stafford loans, and all other federal financial aid.

It's strange how in one paragraph you complain about too much government, and in the next paragraph you're complaining that it isn't helping you enough. Just reminds me again of the eternal hypocrisy - people who are against government funding of healthcare, but LOVE government funding of tuition and government regulation of malpractice lawyers. And, of course, hate arguing with insurance companies over necessary treatments.

 

[Parts Unknown]

Can anyone comment on this? MetalgearHMN?

The legislation actually increases Medicaid payment rates to match Medicare payment rates (which are much higher) for a variety of primary care services, but it does so for only two years. I'm expecting 24+ months of serious lobbying by the internists and family docs to extend that payment structure.

Most of the cost control measures in the bill fall into two categories: cutting outright fraud and waste from Medicare, and a bunch of pilot /demonstration projects that may or may not realize any savings or improvement in care.

 

[huskerdye]

This is why insurance companies are absolutely destroying medicine and families.

However, if the family could somehow pay for this total bill up front, I would assume they wouldn't have to pay even half as much.

 

[PremedGunner]

"Poor people are lazy! They don't deserve healthcare. And our country's broke!" - Typical Republican

"Universal healthcare is communist! And it's un-American! And the rich won't make as much money as they used to! And everybody knows that people who support universal healthcare HATE god!" - Typical Tea Party Supporter

I guess two things really are infinite. The Universe and human stupidity.

I disagree. The reason for these high health care costs is because the government is clogging up the system. If health care was open to the free market, prices would go down.

 

[surftheiop]

If we want to lower health care costs, then we need to break up the MD/DO licensing cartel that limits the number of health care providers. If somebody wants to go to their barbershop for discount neurosurgery, that should be their choice

 

[NickNaylor]

It amazes me that there are even pre-meds on here that aren't in favor of universal healthcare. Every doctor I've ever met in my entire life has been in favor of it. I don't understand how someone who wants to become a doctor would look the other way as people, potential patients, go untreated.

On another note. I think EMS should definitely be publicly funded. You don't get charged a bill if you call 9-1-1 for any other service, do you? No. Pretty soon they'll be running credit checks in the ED to see whether you'll be able to afford their services or not.

Yeah. I'd like you to tell someone with a curable ailment on their deathbed that they don't deserve treatment. Sorry, but we only treat rich people here. Maybe you could pray?

Are you questioning whether people are against universal coverage or a publicly funded system?

 

[morning]

I disagree. The reason for these high health care costs is because the government is clogging up the system. If health care was open to the free market, prices would go down.

How so? I'm genuinely curious here, not being sarcastic. How does the government make healthcare prices so high, and how would getting "the government" out of healthcare make prices more affordable?

 

[Parts Unknown]

However, if the family could somehow pay for this total bill up front, I would assume they wouldn't have to pay even half as much.

Depends on the hospital. Some will write it off, some will accept incomplete payment, some will accept slow payment, some will put the dogs on you, replete with collection agencies and ruination of credit.

If providers were allowed to bill for what things actually cost this situation might iron itself out over time. Instead they are virtually required to overbill, which is what produces these insane invoices.

 

[NickNaylor]

How so? I'm genuinely curious here, not being sarcastic. How does the government make healthcare prices so high, and how would getting "the government" out of healthcare make prices more affordable?

How does government make healthcare costs so low?

Medicare costs have doubled every four years since the 60s. That can't all possibly be due to expanded coverage.

Your rebuttal?

 

[chibrown01]

I disagree. The reason for these high health care costs is because the government is clogging up the system. If health care was open to the free market, prices would go down.

I'm also curious. How does open market make prices go down??

 

[NickNaylor]

I'm also curious. How does open market make prices go down??

In a truly open market, competition and innovation lead to lower prices (in theory). The company that can offer a better, cheaper product will get more customers and, thus, push out the less attractive options. Companies would either offer a suite of services that people would be willing to pay a higher price for or would find ways to cut their costs enough to cater to a more bargain-minded group.

This assumes two things:

1) the companies won't collude to increase prices, and
2) there's no external player attempting to artificially lower prices (i.e., government systems)

An open market is in contrast to a monopoly in which there is no impetus to innovate or provide better outcomes since, regardless, people HAVE to use your services. It'd be nice if the owners of a monopoly would keep their customers in mind and provide outstanding service and prices out of good will, but IMO this would be much more likely to occur in an open market.

Also understand that most people are for regulation in an open market system. It wouldn't simply be a free-for-all where insurance companies get to do whatever they want. The key point is that all companies play by the same rules. The government doesn't because there is an essentially "infinite" purse from which to draw more and more funds. This is how Medicare "works" even though its costs perpetually increase.

 

[morning]

How does government make healthcare costs so low?

Medicare costs have doubled every four years since the 60s. That can't all possibly be due to expanded coverage.

Your rebuttal?

In your universe, if someone asks why the room is painted white, you think they're asking why it isn't black?

I never said that government drives down the cost of healthcare - I was asking how it keeps it artificially high. I don't see how the government deeply affects it either way. You see how that works? How someone can ask a question about one side of the coin without AUTOMATICALLY IMPLYING they believe in the opposite? That sort of dualistic thinking does you no justice.

HEALTHCARE (not Medicare specifically) costs in general have skyrocketed, and that's proof that it is the government's fault? The fact that insurance premiums have increased well beyond the pace of inflation (131% in the past decade) is because of...Medicare?

You can do better than that. Here's a starting point: The cost of pharmaceuticals. Defensive medicine. Inappropriate care for those who do not benefit from it. Obesity. The baby boomers hitting retirement. Complicated billing and administrative costs due to dozens - hundreds - of different insurance companies. The cost of new technology.

 

[NickNaylor]

In your universe, if someone asks why the room is painted white, you think they're asking why it isn't black?

I never said that government drives down the cost of healthcare - I was asking how it keeps it artificially high. I don't see how the government deeply affects it either way. You see how that works? How someone can ask a question about one side of the coin without AUTOMATICALLY IMPLYING they believe in the opposite? That sort of dualistic thinking does you no justice.

HEALTHCARE (not Medicare specifically) costs in general have skyrocketed, and that's proof that it is the government's fault? The fact that insurance premiums have increased well beyond the pace of inflation (131% in the past decade) is because of...Medicare?

You can do better than that. Here's a starting point: The cost of pharmaceuticals. Defensive medicine. Inappropriate care for those who do not benefit from it. Obesity. The baby boomers hitting retirement. Complicated billing and administrative costs due to dozens - hundreds - of different insurance companies. The cost of new technology.

No, it's not the government's fault. I didn't ask whose fault it was. I'm also not talking about all of the sociological factors that you mentioned. I'm simply talking about health insurance, and, IMO, a private system that is publicly regulated is more sustainable and will lead to better outcomes than a publicly funded system. The costs of pharmaceuticals, obesity, and new technology is outside the scope of this discussion and is really moving in an entirely different direction.

Medicare costs have doubled every four years since the 60s. Private insurance premiums have increased, but not at such a rate (according to your data, this would be ~250% increase in government costs versus ~150% for private costs in the past decade).

I'm answering your question indirectly. I can't point to specific ways the private market reduces costs or how the government system increases costs. If I could, I would be a CEO of an insurer or the head of HHS. I can only point to the effects, and the data suggests that government costs increase at a faster rate than private costs.

Nice try, bro. I especially like that attempt at patronizing me.

 

[RadioCure]

You're creating a false polarization of immigration policy between an open border system, and saying "No" to everyone, when in actuality most countries allow immigration to some extent, but not free flow, so it's a middle-ground. We don't say "Sorry, we're full," but we do limit immigration. This is the system (reality) upon which I base my support for socialized medicine.

I understand that you have a bigger picture for world order, and that socialized medicine may be incompatible with that ideal, but I want to focus on policies which can help real people today, with more practical goals of what society will become (meaning I doubt we'll have open borders anytime soon).

I see no need to refrain from implementing socialized medicine while our borders are still semi-closed. If your ideal is ever realized, then perhaps we can reconsider.

I admit that I came off a bit "polarized" in the way I was describing immigration. I realize that we do now allow some immigration, and that opening the borders can not mean raising the floodgates. If we are to have a government at all, the immigration will have to be controlled to a level that the government can handle it. This level is still much higher than the immigration level we have now (though I can't say how high or how it could be calculated).

I'm not saying immigration policy is nearly as bad as slavery, but to make a cliched analogy, imagine if we lived in pre-civil war America. Would you support any policy that relied on slavery to succeed, and that solidified slavery as the only sustainable option? I just couldn't make the excuse "Well, I just don't see slavery ending anytime soon so I'm trying to be realistic," especially if the policy actually supported and reinforced slavery.

Maybe you could, and maybe this is where we'll have to agree to disagree. I can only accept advancing policy that is as internally consistent as possible, but I understand your hesitation to legislate based on an ideal that may never be realized. Slavery is perhaps an unfair example because, well, it did (mostly) end.

I was comparing sustainability in a semi-closed border society. How are those system unsustainable? They have been running for over half a century, do you have reason to believe they will fail anytime soon?

No, probably not anytime soon, just long-run thinking. I added that as an afterthought in the light of population growth I talked about below, and I sort of regret it. My point was mostly that those countries have even less immigration than us, whether enforced or due to geographic isolation.

That's a valid point that insurance is optional (although that's no longer the case in the US), however people are not completely denied emergency care when they don't have insurance. This creates a system where people volunteer to pay, and some don't. Then the ones that don't end up getting very sick and can't/don't pay their bills so the volunteers end up paying for them as well. Is this fair? No! Why not require everyone to pay their fair share? The other alternative is to deny care to people who can't afford it, which most people will have trouble doing (think empathy).

The point I'm making with immigration is that by keeping the flow of immigrants to a trickle, you are denying care to people who can't afford it; you just don't have to see them because they're outside the border. No matter how you slice it, you will have to deny care to people who aren't paying into the system. Imagine if by defining healthcare as a right, we tried to give it to the whole world. We'd be bankrupt in a day; there simply aren't enough resources for everyone to have the luxury of healthcare, especially with a growing world population. It's another one of those unfortunate realities that we have to come to terms with. We must turn people away from hospitals, whether we put out our hand at the door or outside the country's border.

First, do you propose that we use healthcare restriction as a form of population control? I find that to be unethical, as it favors the death of the poor, perhaps before they have had a chance to work or climb in society.

I wouldn't necessarily call healthcare a form of population control just like I wouldn't call food a form of population control. Both of them are factors that control population dynamics, and both are things that not everyone is going to get, but saying "population control" implies some sort of active measure. It's just semantics I guess, and maybe I didn't understand your point. Just like we can't give food to the world and death of the poor is then favored, we can't give healthcare to the world.

Secondly, you make a lot of claims that just aren't backed by real world observations. You claim that welfare states are unsustainable because they allow the poor to breed uncontrollably, and then we will run out of resources. However, examination of European socialized states shows that they have very stable growth rates and some are even shrinking. This is because elevating people out of poverty causes them to reproduce LESS. It is well known that the impoverished have more children, creating some sort of economic stability means that LESS children are born. This is evidenced by the current population biology of European welfare states. Where is the evidence for your assertions, aside from thought experiments?

I think we agree that with immigration open in these countries, or when the swelling population in the rest of the world makes immigration a problem for them, this would not be the case. I'm assuming you mean my unsubstantiated claims, then, are just in my last paragraph.

I think that I was probably a bit overarching in my claim there, but I think you are doing a bit of the same. I was going to write a big argument on cultural and sociological factors influencing reproduction and how I didn't think it could be as easily applied to the US, but it's a waste of time since my main points are under the assumption that immigration is at least fairly open. I'm willing to concede though that my claims were unsupported in my last paragraph and just stick to the topic I'm actually arguing for. If you think something else is unsupported, let me know.

Also, in case you didn't catch my reply above, the insult actually was directed toward myself. 🙂

 

[FutureCTDoc]

I'm also curious. How does open market make prices go down??

Take a look at LASIK, Breast jobs, people compete on price and on quality. You would have the same competition. LASIK can be had for as little as $400 an eye. When it came it out it was 2K per.

 

[sustentacular]

It wasn't just an appendectomy. This person had a RUPTURED APPENDIX and a long hospital stay.

Of course, if they had had insurance, it might not have gotten to that point.

Well then I'd pay even less. Hospital inpatient services are covered 100% and the 100 ER fee is waived if admitted within 48hrs.

Agreed on the bolded. I see more and more people (at the morgue) who had been sick for days or weeks and didn't seek medical care due to lack of insurance.

 

[chibrown01]

Take a look at LASIK, Breast jobs, people compete on price and on quality. You would have the same competition. LASIK can be had for as little as $400 an eye. When it came it out it was 2K per.

I was curious about the whole 'open market' thing. I didn't know what it really meant until coleontheroll explained it. Thanks though. I get it now

 

[chibrown01]

In a truly open market, competition and innovation lead to lower prices (in theory). The company that can offer a better, cheaper product will get more customers and, thus, push out the less attractive options. Companies would either offer a suite of services that people would be willing to pay a higher price for or would find ways to cut their costs enough to cater to a more bargain-minded group.

This assumes two things:

1) the companies won't collude to increase prices, and
2) there's no external player attempting to artificially lower prices (i.e., government systems)

An open market is in contrast to a monopoly in which there is no impetus to innovate or provide better outcomes since, regardless, people HAVE to use your services. It'd be nice if the owners of a monopoly would keep their customers in mind and provide outstanding service and prices out of good will, but IMO this would be much more likely to occur in an open market.

Also understand that most people are for regulation in an open market system. It wouldn't simply be a free-for-all where insurance companies get to do whatever they want. The key point is that all companies play by the same rules. The government doesn't because there is an essentially "infinite" purse from which to draw more and more funds. This is how Medicare "works" even though its costs perpetually increase.

Thanks for the explanation.

So if health insurance was an open market deal, who would make the rules?? I assume the government. Since healthcare is going to be required soon, won't companies just hike up their prices. Idk.
So an example of open market is car insurance. Right?

 

[jm192]

How about doing something crazy, something radical. Having a years worth of savings, so that you can deal with the fact you might be laid off?

I take it as a pre-med you have $4,800 sitting in the bank to cover your insurance bills. And house payments, utility payments, car, auto insurance, etc. all saved up. You must have one hell of a job as a pre-med.

The fact is, it's not fesible for most people in this country even after 22 years old. People do well to meet end's meet. And you want to get on here and condescend that they should be putting money back?! Being able to pay the insurance bill a year from now does you no good when the kids want to eat today.

And as a place visited by pre-meds, you think we have jobs that allow that type of stuff? After I lost that Job as CEO of Apple, I haven't even been able to find work.😉

 

[FutureCTDoc]

Thanks for the explanation.

So if health insurance was an open market deal, who would make the rules?? I assume the government. Since healthcare is going to be required soon, won't companies just hike up their prices. Idk.
So an example of open market is car insurance. Right?

No, they're heavily regulated on the state level. An example is lamps or any good with low barriers to entry.

 

[Parts Unknown]

Take a look at LASIK, Breast jobs, people compete on price and on quality. You would have the same competition. LASIK can be had for as little as $400 an eye. When it came it out it was 2K per.

The so-called free market works when applied to elective out-patient procedures with low overhead and a multitude of providers. That does not extrapolate into the health care system at large, and the reasons should be obvious. When a patient is going to really rack up some expenditure through, say, major cardiac surgery, organ transplantation, or cancer therapy, one does not typically comparison shop for ERs, ORs, ICUs, chemotherapy, etc. In emergent situations decisions are made by proximity; in non-emergent ones reputation plays more of a role.

Here is an interesting graph to chew on:

 

[morning]

No, it's not the government's fault. I didn't ask whose fault it was. I'm also not talking about all of the sociological factors that you mentioned. I'm simply talking about health insurance, and, IMO, a private system that is publicly regulated is more sustainable and will lead to better outcomes than a publicly funded system. The costs of pharmaceuticals, obesity, and new technology is outside the scope of this discussion and is really moving in an entirely different direction.

Medicare costs have doubled every four years since the 60s. Private insurance premiums have increased, but not at such a rate (according to your data, this would be ~250% increase in government costs versus ~150% for private costs in the past decade).

I'm answering your question indirectly. I can't point to specific ways the private market reduces costs or how the government system increases costs. If I could, I would be a CEO of an insurer or the head of HHS. I can only point to the effects, and the data suggests that government costs increase at a faster rate than private costs.

Nice try, bro. I especially like that attempt at patronizing me.

I don't have any preference about what the best system would be. What I care about is allowing more people access to the system before they are deathly ill. If a "private system that is publicly regulated" can be shown to be the best way to do that, then that's great. The key is the regulation. Corporations do not have the same interests as private citizens.

Unfortunately, I think the regulations that would help consumers the most are the ones insurance companies would fight hard against, like the part of this year's health care reform package that fines companies for denying policies over pre-existing conditions. I just don't see how private insurance companies can possibly stay in business WITHOUT harming consumers, because their existence depends on DENYING care for the sick. If they APPROVE care, they lose money. Every single time they approve a claim, they hurt. In the meantime, they cause a lot of grief for the employers who have to buy expensive coverage or refuse benefits for their employees, physicians who have to argue for treatment, and customers who have to worry about whether their claims will be approved.

 

[FutureCTDoc]

The so-called free market works when applied to elective out-patient procedures with low overhead and a multitude of providers. That does not extrapolate into the health care system at large, and the reasons should be obvious. When a patient is going to really rack up some expenditure through, say, major cardiac surgery, organ transplantation, or cancer therapy, one does not typically comparison shop for ERs, ORs, ICUs, chemotherapy, etc. In emergent situations decisions are made by proximity; in non-emergent ones reputation plays more of a role.

Here is an interesting graph to chew on:

Quite frankly I'm of the opinion pony up or die. I don't believe there is a right to healthcare. I also believe the US spends way too much on chemo for terminal onc patients. Insurers shouldn't have to pay for life extending but non-lifesaving treatments. As to CT surg most of that is brought on by a lifetime of poor decisions, most healthy, svelte people don't need quadruple bypasses.

 

[tweek125]

I'm glad you mentioned pre-meds specifically (even though you mentioned Doctors later in your post). I think you'll change your mind eventually.

I love seeing the patients who receive ~$1000 per month from the government to live and are still homeless. This guy ended up in a psych hospital but admitted that "I would rather get $1000 in PCP per month and be homeless." People abuse the hell out of the system and I don't feel like giving everyone a free ride.

There are systems in place for those who are hard working and try to succeed.. There are systems in place for those who are disabled and can't provide for themselves. I have no tolerance for the lazy drug addicts who want a free ride for their entire life.

As a doc I'm going to 1) have to make less money and 2) pay more in taxes so that these people "get what they deserve". Yet no one is helping me with my ~$300k in debt. Sounds fair to me!

I suppose that's a good point about the whole debt thing. it would be easier it everything was publicly funded, including higher education (just look at Europe). In the UK, although i don't think the universities there are completely publicly funded, the doctors accept a lower salary in exchange for less liability (they don't pay their own malpractice insurance from their paycheck).

my point is, basically, Europe has it right.

 

[FutureCTDoc]

I suppose that's a good point about the whole debt thing. it would be easier it everything was publicly funded, including higher education (just look at Europe). In the UK, although i don't think the universities there are completely publicly funded, the doctors accept a lower salary in exchange for less liability (they don't pay their own malpractice insurance from their paycheck).

my point is, basically, Europe has it right.

Why is that better? In case you didn't know the UK has significantly poorer opportunities for the poor. Most students in medical schools come from elite private high schools. In the US our system promotes equal opportunity. All of the things that they are provided cost, it just comes out in taxes.

 

[avatarftw]

Hmm, so you want to make 60,000 (I don't have the exact figures about how much the European docs make) while paying most of that in taxes to get a free med school education. Wrong.

The US alternative is to have ~200,000 in med school debt (its heavily variable based on your rent and personal lifestyle. Some people choose more expensive schools for the experience when they have the option of attending a cheaper med school)

For example, I'll have about 180,000 in debt after med school (it will go down slightly in residency since I'll be renting a cheap apartment--no mortgage) and will have to devote 33,000 GROSS for 20 years to pay it off.

Its not that bad. EM can make 250,000 GROSS so I could be pulling in 217,000 GROSS instead of 250,000. It sucks to pay so much since med school tuition is ~3 times more expensive than it was in the early 1980's in real dollars (not absolute dollars) but its NOT a game-changer.

I don't understand why people get so irrational because of debt. Wait--OVERLY irrational.

I suppose that's a good point about the whole debt thing. it would be easier it everything was publicly funded, including higher education (just look at Europe). In the UK, although i don't think the universities there are completely publicly funded, the doctors accept a lower salary in exchange for less liability (they don't pay their own malpractice insurance from their paycheck).

my point is, basically, Europe has it right.

 

[FlowRate]

Everyone has healthcare ACCESS. What people want is the rich to pay for the poor's healthcare. This is the inherent disagreement: is healthcare a RIGHT? (answer, no, because you have to infringe on other people's rights if you make it a right.) Then, if healthcare is not a right, why should everyone have it? How can we afford to pay for everyone to have it? What are the effects of making everyone's healthcare "free?" (PS protip: no good is free in life.)

The government is inherently inefficient. That is why it influences prices; you have to deal with all of the extra paperwork, the employees to do your paperwork for you, the government employees who do the paperwork for the government, the fat cat bastards who make up reasons for more paperwork, etc. etc. Plus private insurance rates are keyed off of medicare, so the government does, in fact, dictate prices with a gun to your head. It's like a cop pulling out his gun at the store and saying "I want this doughnut half off, plus you have to send a letter to the station for payment. Make sure the letter specifies the date, time, ingredients in the doughnut, and my badge number." So now the doughnut man has to charge more from other people because cops keep coming in and getting donuts half price.

 

[JDCurtis]

Hmm, so you want to make 60,000 (I don't have the exact figures about how much the European docs make) while paying most of that in taxes to get a free med school education. Wrong.

These are average GP salaries for circa 2007.

England = 103,500 pounds a year
N. Ireland = 91,500 pounds a year
Wales = 92,000 Pounds a year
Scotland = 83,000 Pounds a year

And * about 1.56 to convert to dollars. So GP salaries in England don't seem that much less than average US GP salaries, but cost of living is higher.

 

[morning]

Hmm, so you want to make 60,000 (I don't have the exact figures about how much the European docs make) while paying most of that in taxes to get a free med school education. Wrong.

The US alternative is to have ~200,000 in med school debt (its heavily variable based on your rent and personal lifestyle. Some people choose more expensive schools for the experience when they have the option of attending a cheaper med school)

For example, I'll have about 180,000 in debt after med school (it will go down slightly in residency since I'll be renting a cheap apartment--no mortgage) and will have to devote 33,000 GROSS for 20 years to pay it off.

Its not that bad. EM can make 250,000 GROSS so I could be pulling in 217,000 GROSS instead of 250,000. It sucks to pay so much since med school tuition is ~3 times more expensive than it was in the early 1980's in real dollars (not absolute dollars) but its NOT a game-changer.

I don't understand why people get so irrational because of debt. Wait--OVERLY irrational.

How do you think cheaper medical schools become cheaper? The Tooth Fairy? Santa Claus? Maybe it's the Easter Rabbit!

 

[TFS]

.

 

[Bacchus]

I have what I consider to be "good insurance" and here's a few estimates based on my insurance website's treatment cost estimator for "in network" facilities around Boston:

EMERGENCY CARE BY PHYSICIAN
Emergency department visit of moderate to severe complexity
Estimated Treatment Cost: $261-342
Plan Responsibility: $241-322
Member Responsibility: $20

HIGH COMPLEXITY EMERGENCY DEPT VISIT (PHYSICIAN COST ONLY)
Standard charge for emergency room visit of high degree of difficulty
Estimated Treatment Cost: $177-231
Plan Responsibility: $157-211
Member Responsibility: $20

EMERGENCY ROOM CHARGES FROM FACILITY
Standard charge for use of emergency room
Estimated Treatment Cost: $716-1,292
Plan Responsibility: $616-1,192
Member Responsibility: $100

LAPAROSCOPIC APPENDECTOMY
Estimated Treatment Cost: $9,573-13,463
Plan Responsibility: $9,493-13,383
Member Responsibility: $80

So depending on how I make my way to the ER to be sent for an appendectomy I might spend about $200

I'm not a surgical resident or attending, but in this case, for an acute case... I don't believe you'd be doing a laproscopic procedure. It would probably be open so the abdomen can be flushed, etc. I don't think there is time for ports to be placed.

Anyone care to comment/correct?

 

[VicodinMan]

I disagree. The reason for these high health care costs is because the government is clogging up the system. If health care was open to the free market, prices would go down.

Me three. This explanation sure sounds interesting.

2) there's no external player attempting to artificially lower prices (i.e., government systems)

Why 2? Just out of curiosity's sake.

The key point is that all companies play by the same rules. The government doesn't because there is an essentially "infinite" purse from which to draw more and more funds. This is how Medicare "works" even though its costs perpetually increase.

Non-sequitur. Are you trying to suggest that governments increase the number of patients thus leading to increased demand which leads to higher prices?

But on your argument as a whole, it's non-unique. It doesn't apply to the real world but to a distant hypothetical world in which HMOs don't spend millions to lobby the government and don't price fix. Also, it doesn't take into account how HMOs work. The whole idea behind a HMO is to make as much profit as quickly as possible? Why? Because it looks good to shareholders and traders alike, who're looking to make quick money. So how exactly does a HMO and the market really reduce prices? It seems to be a lot of wishful thinking.

Medicare costs have doubled every four years since the 60s. Private insurance premiums have increased, but not at such a rate (according to your data, this would be ~250% increase in government costs versus ~150% for private costs in the past decade).

Where did the 250% come from?

No, it's not the government's fault. I didn't ask whose fault it was. I'm also not talking about all of the sociological factors that you mentioned.

..... (Read below)

The government doesn't because there is an essentially "infinite" purse from which to draw more and more funds. This is how Medicare "works" even though its costs perpetually increase.

Really?

I'm answering your question indirectly. I can't point to specific ways the private market reduces costs or how the government system increases costs. If I could, I would be a CEO of an insurer or the head of HHS. I can only point to the effects, and the data suggests that government costs increase at a faster rate than private costs.

An alien called Zertul made Earth and all the people who live on it. I can't point to specific ways why this is true. If I could, I'd be the founder of my own religion or be the head of my own religion.

If we want to lower health care costs, then we need to break up the MD/DO licensing cartel that limits the number of health care providers. If somebody wants to go to their barbershop for discount neurosurgery, that should be their choice

Haha. 👍



Can we please lock this thread before it gets out of control? Please?

 

[Iso4ane]

For those who bring up the U.K and Canada about their healthcare systems, realize that the U.S. has five times as many people, and if the wait times are long already in those countries, they will be even longer here. Not to mention the fact that the US already has a shortage of nurses and primary care docs. Just giving everyone health insurance does not equal everyone having adequate healthcare, and thus does not solve the problem.

If we just improved our education, particularly in the math and sciences and had more people focused into the technology industry (like Japan), and where everyone would be part of some larger corporation which help provide/pay for health insurance maybe there wouldn't be so much of a problem.

In addition, if we were to have gov't subsided healthcare we could always reduce our military expenses, and find a way to make the U.S. totally indispensable so that no one would want to attack us in the first place.

 

[JubJub603]

Holy moly has this thread been a trip so far. I would absolutely love to know the socioeconomic backgrounds of a lot of the posters in here; something tells me it would give a lot of clarity to how they've formed their opinions.

I'm curious to know how those who view healthcare as a privilege justify our tax dollars being used for roads, fire, police, and other services that ensure a basic social safety net. Should these services simply be available to only those who can afford it? If so, why? What makes those with money inherently more deserving of health care or other basic-needs services than those without? Does the child of rich parents somehow deserve medical treatment more than one who has poor parents?

 

[Parts Unknown]

Quite frankly I'm of the opinion pony up or die.

How old are you?

 

[FutureCTDoc]

Old enough to lack empathy for people who elect to self immolate themselves.

 

[VicodinMan]

Old enough to lack empathy for people who elect to self immolate themselves.

I've got a feeling you'll make a great doctor.

 

[Parts Unknown]

Old enough to lack empathy for people who elect to self immolate themselves.

That doesn't really answer the question.

 

[oldbearprofessor]

Quite frankly I'm of the opinion pony up or die. I don't believe there is a right to healthcare. I also believe the US spends way too much on chemo for terminal onc patients. Insurers shouldn't have to pay for life extending but non-lifesaving treatments. As to CT surg most of that is brought on by a lifetime of poor decisions, most healthy, svelte people don't need quadruple bypasses.

Does this apply to children too? If parents do not have adequate insurance for their children, should they be allowed to die? If not, then do you support universal health care rights for children and if so, at what age would you go from "support" to "let them die if they can't pay?"

 

[Parts Unknown]

Everyone has healthcare ACCESS. What people want is the rich to pay for the poor's healthcare. This is the inherent disagreement: is healthcare a RIGHT? (answer, no, because you have to infringe on other people's rights if you make it a right.) Then, if healthcare is not a right, why should everyone have it? How can we afford to pay for everyone to have it? What are the effects of making everyone's healthcare "free?" (PS protip: no good is free in life.)

The right vs. privilege argument is a false dichotomy. Maggie Mahar has articulated at least one alternative viewpoint that I find personally appealing.

The government is inherently inefficient. That is why it influences prices; you have to deal with all of the extra paperwork, the employees to do your paperwork for you, the government employees who do the paperwork for the government, the fat cat bastards who make up reasons for more paperwork, etc. etc.

There is a much better explanation:

The administrative structure of the U.S. health care system consumes a large share of health spending. In 1999, administrative spending consumed at least 31.0 percent of health spending, according to a report in today’s New England Journal of Medicine. In contrast, administrative costs in Canada, which has had a national health program since 1971, are about 16.7% of health spending.

In 1969 administrative personnel accounted for 18.2% of the health care work force in the U.S. By 1999 administration’s share had risen to 27.3% of total employees – a 50% increase. This figure excludes the 926,000 employees in life/health insurance firms, and 724,000 employed in insurance brokerages. Overall, at least 31.0% of health spending was devoted to administration in the U.S. in 1999.

In contrast, administration’s share of health employment in Canada (where a national health program has been in place since 1971) grew only 17% between 1971 and 1986, and has remained virtually unchanged since 1986. In 1996 administrative workers accounted for 19.1% of health employees vs. 27.3% in the late 1990s in the U.S. (both of these figure exclude health insurance company workers, who are far more numerous in the U.S. Administration consumed 16.7% of Canadian health spending in 1999.

The huge gap in administrative costs between the U.S. and Canada arises from their differing mechanisms of paying for health care. While Canada has a single insurance plan, or “single-payer”, in each province that pays the bills for everyone, the U.S. has a complex and fragmented payment structure built around thousands of different insurance plans, each with its own regulations on coverage, eligibility, and documentation.

The participation of private insurers raises administrative costs. The small private insurance sectors in Australia, Canada, Germany, and the Netherlands all have high overheads: 15.8%, 13.2%, 20.4% and 10.4% respectively, far higher than the 1% to 4% overhead of public insurance programs. Functions essential to private insurance but absent in public programs - e.g. underwriting, marketing, and corporate services - account for about two-thirds of private insurers' overhead. In addition, private insurers have incentives to erect administrative hurdles - by complicating and stalling payment they can hold premiums longer, boosting their interest income. Such hurdles also discourage some patients and providers from pursuing claims.

A fragmented payment structure is intrinsically more expensive than a single payer system. For insurers, it means the duplication of claims processing facilities and reduced insured-group size, which increases overhead.

Fragmentation also raises costs for providers who deal with multitudes of different insurance plans - at least 755 in Seattle alone. This means providers must determine each patient’s insurance coverage and eligibility for a particular service, and keep track of varying co-payments, referral networks, approval requirements and formularies. In contrast, Canadian physicians send virtually all bills to a single insurer using a simple billing form or computer program, and may refer patients to any colleague or hospital.

The multiplicity of insurers also precludes paying hospitals on a lump sum, or global-budgeted basis as in Canada. Global budgets eliminate most billing, and simplify internal accounting since costs and charges need not be attributed to individual patients and insurers.

 

[danc]

A family's healthcare coverage lapsed while one of them was between jobs, and as luck would have it they had a serious medical issue, a ruptured appendix. This is their bill for $76,574.85.

An insurance company would be able to pay a fraction of that, but this family has to pay cash out of pocket and will likely go bankrupt because of this. Plus the hospital is probably overcharging for one of the myriad reasons (make up for low insurance payments, medicare payments, etc).

Source

The thread is full of people from New Zealand, Canada, UK etc. telling us how stupid we are. Frankly I think they're right.[/QUOTE

I would ask for an itemize list of thoes pharmacy items; seems a little heavy.

 

[FutureCTDoc]

Does this apply to children too? If parents do not have adequate insurance for their children, should they be allowed to die? If not, then do you support universal health care rights for children and if so, at what age would you go from "support" to "let them die if they can't pay?"

You shouldn't be procreating if you can't afford to support kids.

 

[sustentacular]

I'm not a surgical resident or attending, but in this case, for an acute case... I don't believe you'd be doing a laproscopic procedure. It would probably be open so the abdomen can be flushed, etc. I don't think there is time for ports to be placed.

Anyone care to comment/correct?

I didn't think so either but expected fees and patient contribution was the same for laproscopic or open so I just copy/pasted the one I looked at last.

 

[sustentacular]

Old enough to lack empathy for people who elect to self immolate themselves.

so.... 16?

 

[chman]

Old enough to lack empathy for people who elect to self immolate themselves.

Do your parents still help you out?

Even assuming that you have a well supporting job for you and your family, I think we have all found that that can be taken away rather quickly. My guess is you would be singing a different tune when your wife, daughter, mother, etc. has terminal cancer and can't afford any life saving treatment or at the very least, medication to ease the pain. It really never ceases to astound me...

 

[chman]

You shouldn't be procreating if you can't afford to support kids.

So the millions who have been laid off and were once in a financially stable positions should have seen that coming ten years ago...too bad for that ten year old...

 

[oldbearprofessor]

You shouldn't be procreating if you can't afford to support kids.

Undoubtedly true, but totally unrelated to my question. You see, I am a pediatrician and if a baby is born in our hospital, this baby, a US Citizen, has certain rights whether you agree with them or not. Now, my question is, should we provide care for this baby whose parents cannot support it, or should we let it die if the parents cannot support it? A simple question, then we can move on to my other questions about when we move to a "pay or die" situation. In making health care policy, we have to deal with the reality that children are not always born to parents who have a half million dollars available cash (or insurance) to pay for their unexpected congenital heart disease. Live or die?

Please hurry, I have to start the PGE in the delivery room since the sats aren't so good. I don't have time to investigate the family background to understand why the parents are "self-pay."