Insurers Shifting Blame to Doctors

[mrmilad]

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Looks like Obama's crusade on the insurers has lead them to look for someone to blame, and of course doctors are next. Take a look at this article from today's Nytimes, what do you think?

http://www.nytimes.com/pages/health/index.html

 

[Omni]

I will admit that some doctors in private practice charge a superfluous amount for common procedures. Its similar to the who car mechanic industry where some mechanic says to an innocent woman that "the discombobulator of your cars gyroscope was damaged, so I'll replace it for $6,000, and have your car running like new"

However, as for the doctors working in hospitals, one must keep in mind that these doctors don't make up the prices. It is done directly through the hospital, which in a sense is a business that must keep a look for its profits and what not.
To blame all doctors over the bad doings of some.

And for the differences in those surgery prices mentioned, the article never goes into explanation of what the differences were. I doubt those were the same types of surgeries that one had an expensive price tag to and the other was cheap. Honestly, what NYT was writing was the same thing as saying "You got ripped off because I was only charged 20,000 for a car, while you were charged 60,000" Of course differences of car quality, luxury status, brand, etc. need to be taken into account. Correct me if I"m wrong, but there are numerous ways to do cataract surgery, or spinal fusion with a number of different types of equipment.

 

[Parts Unknown]

Most of this stems from obsolete formulas that have proliferated and perverted the reimbursement system. The third party payer, such as Medicare, would say "for service X you will get paid either Y dollars or Z percentage of your fee, whichever is lower." All of a sudden nobody can price anything accurately for fear of automatically getting paid less. Hence everybody inflates their bills, sometimes to obscene levels.

For the patient this is all fine and good if you're covered and the insurer doesn't deny your claims.

For the doctor this is all fine and good if the reimbursement rate is acceptable and the payment is timely.

The people who get screwed are the ones paying out-of-pocket, who have no proxy payment contract through a third party intermediary, and thus get stuck with the artifically inflated bill.

 

[TexasFight]

What's depressing is when you read the comments, and see what the readers of NY Times think. 🙁

 

[wanderer]

What's depressing is when you read the comments, and see what the readers of NY Times think. 🙁

I didn't read it, but most internet commentators, be they on youtube, cnn, or even new york times, are idiots. Let me guess, half of them have anecdotes of their cousin being charged $ 20,000 for a visit to the ER, where the doctor saw the patient for 5 minutes? Did they then go on to imply that all doctors are greedy *****s?

 

[Charles_Carmichael]

I didn't read it, but most internet commentators, be they on youtube, cnn, or even new york times, are idiots. Let me guess, half of them have anecdotes of their cousin being charged $ 20,000 for a visit to the ER, where the doctor saw the patient for 5 minutes? Did they then go on to imply that all doctors are greedy *****s?

More like 99% of the commentators seem to believe that doctors are greedy *****s. I doubt that the people commenting on such articles are representative of the entire population though. Hopefully, most people understand that most doctors aren't out to screw over everyone else.

I generally don't read the NYT to get any actual facts though; they're pretty biased against doctors in general. I feel like they're taking some extreme examples seem to be implying that they're a very common occurrence.

 

[Trexate]

This one made me lol.

"I'm uninsured. When I go to the doctor, I have to pay cash and I'm charged a lot more than persons whose insurers have cut a deal with the healthcare provider. In what other area is the buyer penalized for paying cash upfront?"

These are the people that skew the statistics. How many people out there like this can afford insurance, but choose not to have it? Then they complain when they fall ill and can't afford to get it taken care of. People will pay $3,000 to fix an active control differential on a car, but they won't pay $3,000 for a discectomy so they can walk without being in pain. Unfortunately, we can't change the way people think, so let's do the next best thing. Give them what they won't pay for, for free.

 

[astrocreep96]

What's depressing is when you read the comments, and see what the readers of NY Times think. 🙁

The comments are made by a bunch of damned idiots with absolutely no sense of reality. Yes, a flat fee for a spinal fusion makes all the sense in the world. $10/hour, double that if you want an anesthesiologist and $5 per nurse. While we're at it, perform the surgery in a field of flowers and gumdrops and oh so many sweet, simpler things.

 

[astrocreep96]

Oh, and now that I think about it, to the lady that complained about the $6,000 charge for stitches: tell her you're going to charge $12,000 an hour and if she wants, you'll get it done as fast as you possibly can. Then watch her wretch at her competing urges to have it done cheaply or have it done well.

(realistically $6K seems a bit much, but I'm not going to comment on it too much because we don't know a whole lot about the condition of the hospital's finances, their patient population, etc.)

 

[Parts Unknown]

These are the people that skew the statistics. How many people out there like this can afford insurance, but choose not to have it? Then they complain when they fall ill and can't afford to get it taken care of. People will pay $3,000 to fix an active control differential on a car, but they won't pay $3,000 for a discectomy so they can walk without being in pain. Unfortunately, we can't change the way people think, so let's do the next best thing. Give them what they won't pay for, for free.

Is your platitude getting sore?

 

[Trexate]

Is your platitude getting sore?

You don't think there is something wrong with people who will pay to fix a car but not themselves?

 

[Omni]

You don't think there is something wrong with people who will pay to fix a car but not themselves?

How many people have you met that would rather fix their car than pay some cash to get themselves fixed?
And can you link to some statistics or a source that mentions people who can afford, but choose not to buy healthcare?

 

[turkeyjerky]

The comments are made by a bunch of damned idiots with absolutely no sense of reality. Yes, a flat fee for a spinal fusion makes all the sense in the world. $10/hour, double that if you want an anesthesiologist and $5 per nurse. While we're at it, perform the surgery in a field of flowers and gumdrops and oh so many sweet, simpler things.

Lol, man o man--the commenters on nytimes.com are ridiculous.

Anyone ever read the comments on the Well blog? Spend half an hour on it and you're bp'll skyrocket.

 

[Trexate]

How many people have you met that would rather fix their car than pay some cash to get themselves fixed?
And can you link to some statistics or a source that mentions people who can afford, but choose not to buy healthcare?

I have relatives, friends, and acquaintances that have demonstrated that they would rather fix something they own rather than fix themselves.

http://www.ncpa.org/pub/ba460

Declining employer health coverage adds a hefty sum to your paycheck, something I think we can all agree would be nice, especially in a struggling economy. However, when it comes time that people need the insurance and don't have it, they decry the high cost and complain about fairness. These people don't lack insurance because they can't afford it. They lack it because they don't want to afford it.

Give insurance to the people who really can't afford it, but don't act like all 15% of uninsured Americans are that way because they're poor.

 

[VassarLiberal]

They lack it because they don't want to afford it.

In many cases, this is true –*as you said. Their "want," in some sense, seems to be driven by poor understanding of risk, no?

 

[Trexate]

In many cases, this is true –*as you said. Their "want," in some sense, seems to be driven by poor understanding of risk, no?

It's difficult to say what their want is driven by. I'd like to think that the vast majority of it is not understanding the risks, or just being poor with risk assessment. Because at least in that case education can solve the issue.

I'm sure there are some people who understand the risks involved and simply don't want to give money to a company "just in case." I'm one of those people. The difference is, I still do it even though I don't want to because it's the responsible thing to do.

Unfortunately I'm not convinced that people are as unaware of the risks as they claim. Health care costs haven't exactly just sprung up over night. They've been in the public eye for quite some time. Maybe not with the kind of press they are getting now, but they haven't really been kept a secret either.

 

[Parts Unknown]

You don't think there is something wrong with people who will pay to fix a car but not themselves?

I have a problem with handwaving.

Handwaving

n.

Usually insubstantial words or actions intended to convince or impress.

 

[bamtuba]

I didn't read it, but most internet commentators, be they on youtube, cnn, or even new york times, are idiots. Let me guess, half of them have anecdotes of their cousin being charged $ 20,000 for a visit to the ER, where the doctor saw the patient for 5 minutes? Did they then go on to imply that all doctors are greedy *****s?

1. These idiots vote (or at least have the right to do so).

2. These idiots will one day be your patients.

I am not for or against your statement, but just wanted to point this out.

As to the title of this thread, I like to think of the blame game as another example of things being in equilibrium. There is a constant shift of blame all around, but really the "public" thinks everybody (insurers, govt., doctors, nurses, etc.) sucks and makes them pay too much (ie. anything) for the coverage that many believe is covered under "the pursuit of happiness." So really, there is just an overall balance of blame for everyone! Yay.

Yeah. Sad but true.

 

[Trexate]

I have a problem with handwaving.

Handwaving

n.

Usually insubstantial words or actions intended to convince or impress.

Yeah, too bad insulting me doesn't invalidate my point. Better luck next time. GG.

 

[rigel]

I'm sure there are some people who understand the risks involved and simply don't want to give money to a company "just in case." I'm one of those people. The difference is, I still do it even though I don't want to because it's the responsible thing to do.

You'll pull a muscle patting yourself on the back like that.

 

[Trexate]

You'll pull a muscle patting yourself on the back like that.

I pay my own bills. Go me!

 

[boaz]

Looks like Obama's crusade on the insurers has lead them to look for someone to blame, and of course doctors are next. Take a look at this article from today's Nytimes, what do you think?

http://www.nytimes.com/pages/health/index.html

You think that's bad? Check out this one:

http://online.wsj.com/article/SB10001424052970204886304574308472181248330.html

For some reason ony the WSJ thought it worthy to comment on Obama's Doctor Libel. Seems like all others are in agreement with him.

Why does the medical community keep getting such libelous criticism? Because we prefer to focus on our work and don't have time for PR.

 

[Parts Unknown]

Yeah, too bad insulting me

Calling you stupid would be an insult. Saying your "argument" lacks substance is merely an observation.

doesn't invalidate my point.

That's just it, you don't have a point. You have a string of unsubstantiated proclamations. Here is what you said:

These are the people that skew the statistics.

What statistics?

How many people out there like this can afford insurance, but choose not to have it?

You tell us.

People will pay $3,000 to fix an active control differential on a car, but they won't pay $3,000 for a discectomy so they can walk without being in pain.

How many people do this, and what impact does it have on the health system?

 

[Parts Unknown]

Why does the medical community keep getting such libelous criticism?

Because it's rooted in truth, which is difficult for many of us to accept. I spent three years moonlighting during my residency, working for extra money. My job amounted to grossing (processing) specimens submitted to a private pathology lab. Probably >80% of the biopsies I received were skin biopsies from outpatient dermatology clinics, and probably >80% of the dermatologists would write "mass" as the clincial description of almost everything they submitted.

This is important because when you call something a mass you bill more than if you can put another name to it. I could get 50 nevi (moles) or skin tags, each called a mass. This really stood out because some of the dermatologists would call a nevus a nevus, or a skin tag a skin tag, and reserve the term "mass" in cases of diagnostic uncertainty.

Perhaps this is reflective of the culture in that one particular area, but you can't tell me that some doctors don't make coldblooded and questionable choiced to increase revenue. I also cannot say I necessarily blame them. Time has seen reimbusements cut and income erode, and collectively we have acted to preserve our finances.

There are many other examples, not limited to many bypass grafts, angioplasties and stents. Again, it's not that we have some evil cabal of doctors who sit around plotting unnecessary procedures; bypassers bypass, angioplasters angioplast, and stenters stent. But to claim there is no incentive to misbehave, or that nobody does it, is simply disingenuous.

 

[wanderer]

nm

 

[Trexate]

I'll bite Parts, one last time.

I took you including the definition as a clear sign of condescension. Even if I hadn't known what handwaving meant, it would be hard to make it 20+ years without figuring out what a dictionary is for.

Just because you don't see my point doesn't mean there isn't one. There were two points, which should have been separated by some white space. One, don't QQ if you choose to not have insurance and then have to pay a hefty fee to maintain your health. The second point was to highlight the incongruence in people's priorities. Money has an interesting way of doing that.

In reference to point 1:
The statistics I was referencing are those referring to uninsured Americans. Admittedly this could have used a better explanation, but my original sentence came off too wordy. People tout the 15% around like it's the coupe de grace of the health care argument, making it seem like 15% of America can't afford it because it's too expensive. Obviously that isn't the case.

In reference to point 2:
My dad has a slipped disc. He consistently walks around (barely) in pain and complains about it all the time. However, if his truck breaks down, it's a matter of hours before he's got an appointment to get it looked at. He'll pay to fix the truck, but won't pay to fix himself. Why? Because it's "too much money."

I see it with other relatives and I've talked with co-workers about it happening to them. I've seen people come into the ER for similar reasons. It's cheaper in the short term for them to treat the pain rather than the cause. It happens on a regular basis, sacrificing health care for more tangible stuff, and if you don't see it happening perhaps you should spend some time with people who actually have to be concerned about their finances. It bears no real burden on the health care system, but I wasn't trying to imply that it did.

Back to point 1 again:
And now, links to validate my claims.

The only version you didn't have to sign up for was hosted on someone's blog:
http://john-goodman-blog.com/files/hlthaff.26.1.w22v1UninsuredandAffordability.pdf

For those that don't feel like reading it, it suggests that 20% of the uninsured in America can afford it.
Also: http://www.ncpa.org/pub/ba379

The statements I made were not intended to be seen as 'facts,' but merely to get people to think about things from different perspectives. It's really not that outlandish to suggest there are people out there who can afford coverage and choose not to, to save themselves some money in the short term. Nor is it outlandish to suggest that in this society that people would rather have 'stuff' than a clean bill of health.

Fin​

 

[redsquareblack]

People will pay $3,000 to fix an active control differential on a car, but they won't pay $3,000 for a discectomy so they can walk without being in pain.

Where in God's name can you get a discectomy for $3,000?!

 

[dr seuss]

.

 

[Trexate]

That's what I was wondering too. Even after insurance I still had to pay $7000 for mine.

The number was used for simplicity to illustrate a point, and not necessarily indicative of the actual costs of either the ACD or discectomy.

Gotta have the right insurance. $1300 (actual cost) out of pocket with Blue Cross. Leominster Hospital.

 

[Parts Unknown]

I'll bite Parts, one last time.

Thank you for taking the time to better explain yourself and actually post some links.

I fully agree that somewhere around 20% of the uninsured could afford insurance but choose not to. That sucks, but it's a free country.

That number implies, however, that 80% of the uninsured cannot afford insurance, but are charged more than the rest of us due to an unrelated artifact of the billing process. I find that pretty messed up.

and if you don't see it happening perhaps you should spend some time with people who actually have to be concerned about their finances.

If you're talking about me personally, I'm hoping to get my net worth above $0 by 2013 or 2014.

Perhaps this issue irks me because I have seen, with my own two eyes, people forgo necessary, potentially life saving medical care for financial reasons. It's a real Catch-22, and not one that should be seen in a nation that spends as much on healthcare as we do.

 

[bamtuba]

I fully agree that somewhere around 20% of the uninsured could afford insurance but choose not to. That sucks, but it's a free country.

For now. But soon, I will be paying even more to let those same people have a free (for them) option. Not what I call a "free country."

Oh well.

But I also hate these discussions because when it all boils down to it, someone has got to pay for healthcare when it is provided. I just don't like being FORCED to pay for others. But the alternative sucks for the poor (and I speak from experience).

I'm just sick and tired of ALL sides trying to push political agendas while promoting any health care bill disquised as "the best thing we can do now instead of keeping the messed up thing we currently have."

 

[Parts Unknown]

For now. But soon, I will be paying even more to let those same people have a free (for them) option.

How will you soon be paying to give the "affluent uninsured" a free option?

 

[boaz]

Because it's rooted in truth

Is it also true that since there are some teachers who molest students the President should announce that education should be reformed because of that?

The rare cold blooded money-based clinical decisions are not the root of the problem, and I think that Obama's comment was his biggest gaffe ever. It shows that he comes to the debate with gross misconceptions.

 

[denner]

Ouch, my hospital charges patiens just 10 dollars for them stitches in the ER (course, I live in a third world country where healthcare only costs like 10% of what it costs in the US and I work in an underfunded public hospital for the uninsured, but 10 bucks for pretty quick medical treatment and the drugs come free sure ain't a bad deal).

I do some pretty wicked stitches, w00t. One of my hard to please superiors keeps on bragging how sweet I stitched this near imposible skin lesion on a woman's leg a few weeks ago. We even do stitches for free if the patients really does have no dough, they do have to pay for the antibiotics and analgesics out of their pocket.

My income is fixed, I earn as much cash attending 1 patient in a day than 50 patients. Attendings have fixed incomes as well, so to say we're greedy bastards has no foundation. We charge really little cash for treatments and a lot of patients have this abomination called "Seguro Popular" (basically meaning attendings physicians and anyone else with upper education and decent paying jobs have to pay ever higher taxes to near unsustainable limits so that lower socioeconomic populations get to enjoy having even more children they can't afford to maintain, live on welfare and even demand us doctors to give them VIP treatment to boot.

I can be rude sometimes, but geesh, some patients are jerks. Especially the ones with seguro popular insurance (they don't pay squat taxes to sustain that abomination dammit!!), they show up in the ER at hideously late hours for things that aren't emergencies and get angry and threaten to sue the hospital 🙂rolleyes🙂 if their non emergency isn't attended before that unconscious person suffering an epileptic attack. At the same time I'm always very nice and awesome with the really nice and well meaning patients & relatives even when I'm insanely tired and busy.

Patients usually don't put themselves in our shoes that we're overworked, underfed and insanely stressed.

You may be in a "third world country," but that sounds a heck of a lot like America nowadays.

 

[TopSecret]

Ouch, my hospital charges patiens just 10 dollars for them stitches in the ER (course, I live in a third world country where healthcare only costs like 10% of what it costs in the US and I work in an underfunded public hospital for the uninsured, but 10 bucks for pretty quick medical treatment and the drugs come free sure ain't a bad deal).

I do some pretty wicked stitches, w00t. One of my hard to please superiors keeps on bragging how sweet I stitched this near imposible skin lesion on a woman's leg a few weeks ago. We even do stitches for free if the patients really does have no dough, they do have to pay for the antibiotics and analgesics out of their pocket.

My income is fixed, I earn as much cash attending 1 patient in a day than 50 patients. Attendings have fixed incomes as well, so to say we're greedy bastards has no foundation. We charge really little cash for treatments and a lot of patients have this abomination called "Seguro Popular" (basically meaning attendings physicians and anyone else with upper education and decent paying jobs have to pay ever higher taxes to near unsustainable limits so that lower socioeconomic populations get to enjoy having even more children they can't afford to maintain, live on welfare and even demand us doctors to give them VIP treatment to boot.

I can be rude sometimes, but geesh, some patients are jerks. Especially the ones with seguro popular insurance (they don't pay squat taxes to sustain that abomination dammit!!), they show up in the ER at hideously late hours for things that aren't emergencies and get angry and threaten to sue the hospital 🙂rolleyes🙂 if their non emergency isn't attended before that unconscious person suffering an epileptic attack. At the same time I'm always very nice and awesome with the really nice and well meaning patients & relatives even when I'm insanely tired and busy.

Patients usually don't put themselves in our shoes that we're overworked, underfed and insanely stressed.

This is what happens when health care is socialized and you are working for slave wages and unable to protest/strike. You will be thrown in jail if you so much as raise your voice against the regime.

Also, beware of the illusion of wealth when the government takes away a huge chunk of your government salary because of taxes.

 

[TopSecret]

You may be in a "third world country," but that sounds a heck of a lot like America nowadays.

When taxes are high, the taxpayers run away.

Look what's happening to California with a state income tax of more than 10%, one of the highest tax rates in the nation. The movie industry runs away to Canada and other states that offer tax credits.

http://foxandhoundsdaily.com/blog/g...s-tax-credits-fight-film-production-predators

 

[Parts Unknown]

Is it also true that since there are some teachers who molest students the President should announce that education should be reformed because of that?

The rare cold blooded money-based clinical decisions are not the root of the problem, and I think that Obama's comment was his biggest gaffe ever. It shows that he comes to the debate with gross misconceptions.

I'm afraid you cannot simply brush if off that easily. When critics say that the financial incentives in medicine are "perverse," they are not kidding or exaggerating. Insurers and hospitals regularly engage in activities both calculating and callous to further the bottom line. The admission timing of Medicare patients, for instance, has been routinely manipulated to maximize payment ("new" admissions pay more than readmissions).

America will spend X number of dollars on health care next year. Now imagine all that money is sitting in a trough in Thunderdome, and every insurer, hospital, provider, pharma, medical equipment maker, etc. is a road warrior gearing up to fight for the largest slice of that pie that they can get. It gets a little messy.

 

[boaz]

I'm afraid you cannot simply brush if off that easily. When critics say that the financial incentives in medicine are "perverse," they are not kidding or exaggerating. Insurers and hospitals regularly engage in activities both calculating and callous to further the bottom line. The admission timing of Medicare patients, for instance, has been routinely manipulated to maximize payment ("new" admissions pay more than readmissions).

America will spend X number of dollars on health care next year. Now imagine all that money is sitting in a trough in Thunderdome, and every insurer, hospital, provider, pharma, medical equipment maker, etc. is a road warrior gearing up to fight for the largest slice of that pie that they can get. It gets a little messy.

We seem to be addressing two different issues. I am talking about a doctor who decides he would rather cut stuff out a child's throat (with all the risks of surgery) in order to make money, even though the child does not need it at all. The suggestion that this is common is repulsive and insulting.

You are talking about petty cheating of the system. This is much more common, and it would be very naive to think that such behavior is very rare. Our own Secretary of the Treasury made a few "technical mistakes" on his tax returns. And a few dermatologists you know "mistake" a lot of moles for skin tags.

Whether or not the latter is a major cause in healthcare inflation is debatable (I disagree). But the former is not.

 

[Parts Unknown]

We seem to be addressing two different issues. I am talking about a doctor who decides he would rather cut stuff out a child's throat (with all the risks of surgery) in order to make money, even though the child does not need it at all. The suggestion that this is common is repulsive and insulting.

You are talking about petty cheating of the system. This is much more common, and it would be very naive to think that such behavior is very rare. Our own Secretary of the Treasury made a few "technical mistakes" on his tax returns. And a few dermatologists you know "mistake" a lot of moles for skin tags.

Whether or not the latter is a major cause in healthcare inflation is debatable (I disagree). But the former is not.

No, they are part and parcel of the same fundamental issue: the system permits/encourages seemingly small, independent decisions that are additive to form much larger, system-wide dysfunction.

 

[Parts Unknown]

And a few dermatologists you know "mistake" a lot of moles for skin tags.

If by "a few" you mean >80% of our contracted derm clinics in one of the five largest cities in the country, then sure. And they "mistook" moles and skin tags for masses, not each other.

Even if we assume that this problem is only responsible for a small percentage of overall costs, look at the total numbers. National health expenditure was $2.2 trillion in 2007. Assuming ten years of no growth (ha!) that's $22 trillion. Trimming 4.5% of that would save $1 trillion, which was the now infamous estimated cost of HR 3200.