Oklahoma Doctors vs. ObamaCare

[NoHumbug]

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Watched this interesting Reason.TV video today.

[YOUTUBE]0uPdkhMVdMQ[/YOUTUBE]

I thought about posting it here because the co-founder and managing director is an anesthesiologist. As a medical student that really wants to go into anesthesiology, I was hoping to get some perspective from those already in the field as to the viability of this kind of option. How much of the lowered prices do you think comes from lowered physician reimbursement?

 

[chocomorsel]

Watched this interesting Reason.TV video today.

[YOUTUBE]0uPdkhMVdMQ[/YOUTUBE]

I thought about posting it here because the co-founder and managing director is an anesthesiologist. As a medical student that really wants to go into anesthesiology, I was hoping to get some perspective from those already in the field as to the viability of this kind of option. How much of the lowered prices do you think comes from lowered physician reimbursement?

Impressive. I think it's a good and fair business model. Markup is ridiculous when it comes to hospital bills as we all know. Although I thought that insurance companies cover on average 30-40% of what's billed to them.
I think that this is something that could totally work and save people money in the right setting. And still make the physicians/nurses/staff money without having to deal with lovely administrators.

 

[HollywdAnesth]

I am going to Tweet this out. A great video. Thanks for sharing.

 

[Perrotfish]

I thought about posting it here because the co-founder and managing director is an anesthesiologist. As a medical student that really wants to go into anesthesiology, I was hoping to get some perspective from those already in the field as to the viability of this kind of option. How much of the lowered prices do you think comes from lowered physician reimbursement?

A deregulated, cash market system is basically the basis for Singapore's healthcare system. It provides outcomes on par with Europe and prices that are amoung the lowest in the world.

The model has not, however, been particularly generous for their physicians. Think about what happened to airline pilots when that industry deregulated. The goods got a lot cheaper, the customers got alot happier, but reimbursement for the top professionals plumetted.

A cash market in a market as regulated as our, in any event, is neither fair nor viable for most Americans. The bubble created by unlimited government funds pouring into healthcare, along with the artifical provider scarcity created by our licensing and residency system, makes even 'cheap' medical care, like the one described in the video, prohibitively expensive. 3,000 dollars for carpal tunnel surgery is only slightly less insane than 7,000 dollars. A cash market would require the industry to be treated like any other. A system where the industry is allowed to collude to limit the supply of their product (physician licensing), where the customer can't buy products directly from the distributor (perscriptions are required to sell drugs), and where the governement is the largest customer (Medicare and Medicaid) will never really function as a cash market.

 

[EtherBunny]

A deregulated, cash market system is basically the basis for Singapore's healthcare system. It provides outcomes on par with Europe and prices that are amoung the lowest in the world.

The model has not, however, been particularly generous for their physicians. Think about what happened to airline pilots when that industry deregulated. The goods got a lot cheaper, the customers got alot happier, but reimbursement for the top professionals plumetted.

A cash market in a market as regulated as our, in any event, is neither fair nor viable for most Americans. The bubble created by unlimited government funds pouring into healthcare, along with the artifical provider scarcity created by our licensing and residency system, makes even 'cheap' medical care, like the one described in the video, prohibitively expensive. 3,000 dollars for carpal tunnel surgery is only slightly less insane than 7,000 dollars. A cash market would require the industry to be treated like any other. A system where the industry is allowed to collude to limit the supply of their product (physician licensing), where the customer can't buy products directly from the distributor (perscriptions are required to sell drugs), and where the governement is the largest customer (Medicare and Medicaid) will never really function as a cash market.

I disagree. I think the lion's share of health care expenses these days is wasted on administrative functions and absurd markups by pharmaceutical and biomedical companies. We need to open the market up such that groups can purchase drugs and equipment at the same prices that, for instance, Canada pays. This will force pharmaceutical and biomedical companies in the U.S. to sell their goods at reasonable prices. The model espoused by the anesthesiologist in the video is great because it eliminates all the administrative bs that is literally crippling the American health care system. We don't need all the MBAs and lawyers dictating how we practice. They don't have a clue about taking care of patients and, more importantly, they don't care about patients. They only care about profit, usually at the expense of the people who actually take care of the patients.

I, for one, would strongly support the model proposed in this video. I think it's a great model with a lot of potential in this country. We need to get all the damn third parties out of the doctor-patient relationship.

 

[DrAwsome]

I disagree. I think the lion's share of health care expenses these days is wasted on administrative functions and absurd markups by pharmaceutical and biomedical companies. We need to open the market up such that groups can purchase drugs and equipment at the same prices that, for instance, Canada pays. This will force pharmaceutical and biomedical companies in the U.S. to sell their goods at reasonable prices. The model espoused by the anesthesiologist in the video is great because it eliminates all the administrative bs that is literally crippling the American health care system. We don't need all the MBAs and lawyers dictating how we practice. They don't have a clue about taking care of patients and, more importantly, they don't care about patients. They only care about profit, usually at the expense of the people who actually take care of the patients.

I, for one, would strongly support the model proposed in this video. I think it's a great model with a lot of potential in this country. We need to get all the damn third parties out of the doctor-patient relationship.

I think what they showed, with having a ton of administrators is very much true. You could probably get rid of 1/2 of all the administrators in hospitals and save millions per hospital. It is absurd how many administrators are present and I think that's one of the big problems with hospitals buying out private practices. Services at hospitals are soooo much more costly than at private practices, so with the gov having all these absurd regulations where physicians pretty much have to work for hospitals, it will make the system not just more inefficient but a lot more $$$.

You also have to realize that the success of this business is that it's CASH - the healthcare group is directly being paid by the employer, with no middle man insurance. So they can get away with charging a lot less because they get everything that they charge for. So they are still making bank while offering much reduced costs. Removing the middle man from the picture would make sense.

 

[Perrotfish]

I disagree. I think the lion's share of health care expenses these days is wasted on administrative functions and absurd markups by pharmaceutical and biomedical companies. We need to open the market up such that groups can purchase drugs and equipment at the same prices that, for instance, Canada pays. This will force pharmaceutical and biomedical companies in the U.S. to sell their goods at reasonable prices. The model espoused by the anesthesiologist in the video is great because it eliminates all the administrative bs that is literally crippling the American health care system. We don't need all the MBAs and lawyers dictating how we practice. They don't have a clue about taking care of patients and, more importantly, they don't care about patients. They only care about profit, usually at the expense of the people who actually take care of the patients.

I, for one, would strongly support the model proposed in this video. I think it's a great model with a lot of potential in this country. We need to get all the damn third parties out of the doctor-patient relationship.

]Everybody in a hospital will always think that everyone else in the hospital is greedy, immoral, and a waste of money. Meanwhile everyone thinks that they are selfless, concerned about the welfare of others, and worth several times whatever they are paid.

The pharm companies are not out to screw you: when governments with socialized healthcare use their unfair negotiating advantage to force pharm companies to sell their products at just over production costs, without accounting for the costs of the dozens of failed clinical traials that offsets each expense, that's not a blow for justice. The machinery of insurance (government or otherwise) isn't out to screw people either, they ensure that people who would have been priced out of a cash market have a mechanism to access care, and they sort through the complicated issues of billing an pricing. Lawyers are awful.. until you need one. The fact is we remediate most of our wrongs in civil court.

I'm not saying there's not a better way to do things, but don't think the problem is just that everyone else is a theif or waste of space.

 

[Izanami]

I think what they showed, with having a ton of administrators is very much true. You could probably get rid of 1/2 of all the administrators in hospitals and save millions per hospital. It is absurd how many administrators are present and I think that's one of the big problems with hospitals buying out private practices. Services at hospitals are soooo much more costly than at private practices, so with the gov having all these absurd regulations where physicians pretty much have to work for hospitals, it will make the system not just more inefficient but a lot more $$$.

You also have to realize that the success of this business is that it's CASH - the healthcare group is directly being paid by the employer, with no middle man insurance. So they can get away with charging a lot less because they get everything that they charge for. So they are still making bank while offering much reduced costs. Removing the middle man from the picture would make sense.

I am not familiar with how these surgery centers are run, but would it be more feasible if there's an option for patients to finance their cost of care? Like in car buying where you put down a sizable down payment and pay the rest via monthly payments for 12 or 24 months. Obviously, a prior credit check is necessary.

 

[bigeyedfish]

I am not familiar with how these surgery centers are run, but would it be more feasible if there's an option for patients to finance their cost of care? Like in car buying where you put down a sizable down payment and pay the rest via monthly payments for 12 or 24 months. Obviously, a prior credit check is necessary.

A lot of practices that don't take insurance, like plastics and crretive eye surgery, do exactly as you describe. There's no reason it couldn't be done for a lap chole or hernia, or valve replacement.

 

[bigeyedfish]

A deregulated, cash market system is basically the basis for Singapore's healthcare system. It provides outcomes on par with Europe and prices that are amoung the lowest in the world.

The model has not, however, been particularly generous for their physicians. Think about what happened to airline pilots when that industry deregulated. The goods got a lot cheaper, the customers got alot happier, but reimbursement for the top professionals plumetted.

A cash market in a market as regulated as our, in any event, is neither fair nor viable for most Americans. The bubble created by unlimited government funds pouring into healthcare, along with the artifical provider scarcity created by our licensing and residency system, makes even 'cheap' medical care, like the one described in the video, prohibitively expensive. 3,000 dollars for carpal tunnel surgery is only slightly less insane than 7,000 dollars. A cash market would require the industry to be treated like any other. A system where the industry is allowed to collude to limit the supply of their product (physician licensing), where the customer can't buy products directly from the distributor (perscriptions are required to sell drugs), and where the governement is the largest customer (Medicare and Medicaid) will never really function as a cash market.

But the dr in video is not highly regulated. Thats the point His only regulation is maintaining his license. Jacho is not welcome at his practice. Cms clipboard nurses are not welcome either. That cuts costs enormously.

I bet if you ask people with cts if it would be worth 3000 to get rid of safely and know they wouldn't die in the process they'd tell you hell yes. What would happen if everyone adopted this model is that competition would decrease this cost, just like it has in cosmetics.

 

[DrAwsome]

But the dr in video is not highly regulated. Thats the point His only regulation is maintaining his license. Jacho is not welcome at his practice. Cms clipboard nurses are not welcome either. That cuts costs enormously.

I bet if you ask people with cts if it would be worth 3000 to get rid of safely and know they wouldn't die in the process they'd tell you hell yes. What would happen if everyone adopted this model is that competition would decrease this cost, just like it has in cosmetics.

Well the problem is that insurance for those with regular jobs who have their employer cover most of the insurance costs are far far cheaper than paying for services outright, even if cheaper. So for example my husband's employer charges him less than 2k for comprehensive, 100% insurance coverage. If he had to pay for each service separately, it would still cost him far more than the 2k that he currently pays. The same happens with a lot of other people. So maybe for the elderly who consume a ton of services, paying some things out of pocket may be cheaper, but if they had to pay for everything out of pocket they would still go bankrupt.

However, I do think that the reduction of a great deal of administrators would reduce costs tremendously.

 

[countingdays]

Well the problem is that insurance for those with regular jobs who have their employer cover most of the insurance costs are far far cheaper than paying for services outright, even if cheaper. So for example my husband's employer charges him less than 2k for comprehensive, 100% insurance coverage. If he had to pay for each service separately, it would still cost him far more than the 2k that he currently pays. The same happens with a lot of other people. So maybe for the elderly who consume a ton of services, paying some things out of pocket may be cheaper, but if they had to pay for everything out of pocket they would still go bankrupt.

However, I do think that the reduction of a great deal of administrators would reduce costs tremendously.

You are confusing the actual cost of his insurance, in decreased wages, with the out-of-pocket cost.

 

[DrAwsome]

You are confusing the actual cost of his insurance, in decreased wages, with the out-of-pocket cost.

No, not really. If his health insurance was not paid for by his employer, he would still not get extra $$$. And the insurance covers everything and anything needed. Even if he were to get the cost of what the employer pays (if he did not have insurance), if he were to have something serious happen, it still would be unaffordable.

Sort of like car insurance-I pay about 650$/year, and have full coverage. I had an accident recently, car cost 10k to fix. So the insurance is covering far far far more than I ever paid in premiums. Sure, I may not have another accident for the rest of my life and there may be other people paying who may not have accidents and their premiums cover my car fix up, but clearly we pay far less than what the insurance covers in cases of catastrophic situations.

 

[EtherBunny]

]Everybody in a hospital will always think that everyone else in the hospital is greedy, immoral, and a waste of money. Meanwhile everyone thinks that they are selfless, concerned about the welfare of others, and worth several times whatever they are paid.

The pharm companies are not out to screw you: when governments with socialized healthcare use their unfair negotiating advantage to force pharm companies to sell their products at just over production costs, without accounting for the costs of the dozens of failed clinical traials that offsets each expense, that's not a blow for justice. The machinery of insurance (government or otherwise) isn't out to screw people either, they ensure that people who would have been priced out of a cash market have a mechanism to access care, and they sort through the complicated issues of billing an pricing. Lawyers are awful.. until you need one. The fact is we remediate most of our wrongs in civil court.

I'm not saying there's not a better way to do things, but don't think the problem is just that everyone else is a theif or waste of space.

Insurance companies aren't out to screw people? Are you being serious? Insurance companies ROUTINELY screw doctors and patients over. Ask any physician in private practice what they think about insurance companies. Get ready for a string of expletives. It ain't good.

Some lovely facts about the wonderful relationship between physicians and insurance companies:

*Insurance companies routinely reject claims submitted by physicians, which forces physicians to hire administrators to deal with insurance companies (so--and I know this is a ludicrous idea--physicians can get PAID FOR THE SERVICES THEY RENDER). The cost of having these administrators can be a substantial portion of any physician's overhead.

*Insurance companies routinely delay reimbursement, on the order of months. In effect, as a physician, you can perform service X for a patient in January and you won't get paid for it until April, May, or June. In the process, you often have to fight with the insurance company just to get paid at all.

*Insurance companies routinely pay a fraction of what physicians charge for their services.

Some lovely facts about the wonderful relationship between patients and insurance companies:

* Premiums have increased by FIFTY PERCENT in the last seven years and deductibles have DOUBLED in the same time period. It's ridiculous to think that the actual cost of taking care of a family of four has increased that much in the last 7 years.

Let's face it: insurance companies are raping the system by denying claims to physicians and shifting the cost of care to patients. Don't even get me started on pharmaceutical and biomedical companies. They're just as guilty of profiteering at the expense of patients and caregivers.

Here's an analogous situation for you...

You own a convenience store that sells twinkies. The company that makes the twinkies, which we'll call company T, only forks out $0.50 to make a pack of twinkies, but they charge you, the storeowner, $150.00 for each pack. Everyday 100 people, who happen to suffer from medically refractory hyperinsulinemia, buy twinkies from you. But only 80 of them actually pay you for the twinkies. Moreover, they don't pay you directly. A different company, let's call it company FU, pays you after you submit documentation proving that you actually handed a twinkie to a customer.

You've had some problems with company FU. First, you've found it really difficult to actually prove to company FU that you handed a twinkie to a customer. Even when it's obvious that you gave the customer a f**king twinkie, company FU will not pay you. When you ask for a reason, they tell you that you failed to document that the customers' shoes were tied during the transactions. When you say that the shoe issue has absolutely no bearing on the twinkie transaction, the only response you get is: "sorry, you should have paid attention to the shoes." Second, even when they do pay you for the sale, they don't give you what you charged. Nope, they give you a fraction of what you charged...several months after the transaction occurred.

When you confront company FU about these issues, they essentially tell you to f**k off: if you don't like the way that they do business, they'll take their twinkie customers to another convenience store. Also, when you talk to company T about their ridiculous markup, pointing out the fact that customers can buy the exact same twinkies in Canada for $1.50, company T simply ignores your complaints.

If you were the storeowner in this scenario, would you think you're being treated fairly by company FU? Would you say that company T is doing the "right" thing for its customers by imposing a 300% markup?

 

[cleansocks]

Insurance companies really arent acting as insurance companies. People take out insurance for catastrophic events. In our system, insurance pays for everything. They should really be called private healthcare allocation agencies. They determine who receives what kind of healthcare and how much the people who provide the care get for their services. They are private companies that have a responsibility towards their shareholders and staff to generate profit which can be achieved in the broadest sense by maximizing premiums and minimizing reimbursement. They have to do this to excess because they pay for everything rather than just the rare catastrophic event. Thus it would seem prudent to change the system so that routine expenses are paid for by consumers while insurance exists for catastrophic events. The problem with this is that the system that exists now has created pricing expectations for healthcare providers and patients that would have to be completely recalibrated. It is difficult to predict where prices would fall. The other problem of course is the ethical dilemma of those who cannot even afford routine care. But overall the system would certainly be more cost effective if insurance companies existed as agencies who only cover rare catastrophic events and people could actually take care of their own health routinely. It would probably incentivize a change in behavior culturally if people had to directly spend their own money to pay for diabetes or hypertension medications.

I have to disagree about pharm companies needing price regulation. The majority of technology and pharm is created within the US because patent law rewards the creation of medical advancement. If you destroy that incentivizing system, you destroy medical innovation. Additionally, we currently have no propofol in our hospital. Thappenstance will happen on a much larger scale if we prevent profit taking.

 

[Gern Blansten]

Insurance companies aren't out to screw people? Are you being serious? Insurance companies ROUTINELY screw doctors and patients over. Ask any physician in private practice what they think about insurance companies. Get ready for a string of expletives. It ain't good.

Some lovely facts about the wonderful relationship between physicians and insurance companies:

*Insurance companies routinely reject claims submitted by physicians, which forces physicians to hire administrators to deal with insurance companies (so--and I know this is a ludicrous idea--physicians can get PAID FOR THE SERVICES THEY RENDER). The cost of having these administrators can be a substantial portion of any physician's overhead.

*Insurance companies routinely delay reimbursement, on the order of months. In effect, as a physician, you can perform service X for a patient in January and you won't get paid for it until April, May, or June. In the process, you often have to fight with the insurance company just to get paid at all.

*Insurance companies routinely pay a fraction of what physicians charge for their services.

Some lovely facts about the wonderful relationship between patients and insurance companies:

* Premiums have increased by FIFTY PERCENT in the last seven years and deductibles have DOUBLED in the same time period. It's ridiculous to think that the actual cost of taking care of a family of four has increased that much in the last 7 years.

Let's face it: insurance companies are raping the system by denying claims to physicians and shifting the cost of care to patients. Don't even get me started on pharmaceutical and biomedical companies. They're just as guilty of profiteering at the expense of patients and caregivers.

Here's an analogous situation for you...

You own a convenience store that sells twinkies. The company that makes the twinkies, which we'll call company T, only forks out $0.50 to make a pack of twinkies, but they charge you, the storeowner, $150.00 for each pack. Everyday 100 people, who happen to suffer from medically refractory hyperinsulinemia, buy twinkies from you. But only 80 of them actually pay you for the twinkies. Moreover, they don't pay you directly. A different company, let's call it company FU, pays you after you submit documentation proving that you actually handed a twinkie to a customer.

You've had some problems with company FU. First, you've found it really difficult to actually prove to company FU that you handed a twinkie to a customer. Even when it's obvious that you gave the customer a f**king twinkie, company FU will not pay you. When you ask for a reason, they tell you that you failed to document that the customers' shoes were tied during the transactions. When you say that the shoe issue has absolutely no bearing on the twinkie transaction, the only response you get is: "sorry, you should have paid attention to the shoes." Second, even when they do pay you for the sale, they don't give you what you charged. Nope, they give you a fraction of what you charged...several months after the transaction occurred.

When you confront company FU about these issues, they essentially tell you to f**k off: if you don't like the way that they do business, they'll take their twinkie customers to another convenience store. Also, when you talk to company T about their ridiculous markup, pointing out the fact that customers can buy the exact same twinkies in Canada for $1.50, company T simply ignores your complaints.

If you were the storeowner in this scenario, would you think you're being treated fairly by company FU? Would you say that company T is doing the "right" thing for its customers by imposing a 300% markup?

Funny analogy. Twinkies are very good...but they're not $150 good. Close though...

 

[lane]

Funny analogy. Twinkies are very good...but they're not $150 good. Close though...

http://www.ebay.com/itm/20-boxes-of...821?pt=LH_DefaultDomain_0&hash=item20cd8df805

 

[bogatyr]

I am curious whether a block +/- catheter is included in the price. The only place it is mentioned is for manipulation under anesthesia.

 

[BobBarker]

They block there. I got my ACL done at that facility in undergrad. They charged my insurance and then I paid the balance on the day of surgery.

On edit: But that really doesn't answer the question of if the cash price includes a block. I would assume it probably does. They either did mine when I was asleep or in PACU when the lights were on but nobody home.

 

[Gern Blansten]

http://www.ebay.com/itm/20-boxes-of...821?pt=LH_DefaultDomain_0&hash=item20cd8df805

I stand corrected. The analogy was actually quite timely, it turns out.

 

[ProwlerturnGas]

It's time to nut up or shut up.....that was one of the best Zombie movies made!

 

[Idiopathic]

why did she go to sleep for CTR