Things about health care system that kills you inside.

[theseeker4]

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Ultimately the real issue is that healthcare is really expensive. And I'm not talking about inflated costs from inefficient delivery systems, "greedy hospitals/doctors/insurance bureaucrats", and all the other problems so frequently brought up. These issues, while important, are largely sideshows. Sure we can always improve the system and minimize those factors, but it will only put a tiny dent in problem. Focusing all our energy on those relatively trivial issues is dangerous because we end up neglecting the address the facts.

Healthcare is expensive. It has to be if it's going to be any good. It starts with the armies of researchers--clinical, scientific, pharmaceutical, etc.--that dedicate their careers to improving our knowledge of human biology. Every single one of these people needs to be compensated for their expertise and efforts. If they aren't, then nobody will go into research and the advance of medicine will halt.

Then there is a long road still from initial research findings to actually producing something useful. For every drug or procedure or instrument that eventually reaches market, many do not. The incredible amounts of labor that go into this effort require a lot of compensation. People still have to get paid for their years of hard work, even if their product, which was initially based on a sound theory, ultimately fails. Otherwise the industry would stall. This is why it is very misleading to say "it only costs 5 cents to make this pill, yet its marked up to $1.50. That's outrageous!! Criminal!"

And so far we've only touched the technology. There is still the physical facilities, many of which must be operational and fully staffed 24/7. And the staff aren't McDonald's minimum wage type workers either. Nurses, techs, security, social workers, etc. all have specialized training and aren't going to work for unattractive salaries. Even if nobody checks into the ER or is admitted to the hospital all night long, every single one of these people still has to get paid for sticking around just in case. The same thing goes for the doctors, except their specialized training is through the roof and they are also entitled to a pay that represents that level of sacrifice/expertise. As mentioned, they still have all their overhead that adds to the cost as well. Plus places like the ER are financial black holes and other departments, like labs and radiology, have to make up the difference for the hospital to break even.

My point is that the cost of healthcare isn't the biggest fish to fry. It's an issue, and can be brought down a little, but the same underlying problems will still exist after you do. The costs are generally fair (yes, that's right) and accurately represent the resources, time, and skill that goes into producing it.

The problem is that very few people can afford the costs associated with the care they would like to consume (that some even consider it their "right" to consume). Behold, the advent of health insurance. Once upon a time people actually thought of health insurance as insurance. When this is the case everything works fine. You still pay your yearly routine costs (deductible) but also contribute to a pool for the unlucky ones who get really hurt/sick (premiums).

But then people started expecting something for nothing. And politicians started demonizing anybody and everybody if it would win them votes. And as a society we let our welfare state grow to an unprecedented size, thus shifting more and more of the costs to the people who work hard and actually contribute something.

Of course nobody with a serious medical condition should go untreated because they can't pay. But at the same time people are going to have to start taking more responsibility for their actions and for what they consume. The ultimate problem is that many in our society are unwilling to do this voluntarily. We need to spend more time and effort addressing this, and the trivialities we are currently obsessed with will work themselves out.

+100 👍

 

[DrDrummer]

Whoa whoa whoa do you mean he's had to consult a DEATH PANEL??

Yes.

And they were driving one of these:

 

[Ursa]

That's my main concern. The PA ordered her to test 3 times a day....the box will only last her for about 33 days. So each month she has to spend $128 on top of other expenses she has to pay for like lab work and her meds etc.

She recently had foot surgery and the cost for lab work alone for that 10 days period she spent in the hospital cost 20K!!! Just for lab work!

I've been trying to talk with the PA and see if he can give her an alternative meter or any other one that will be covered by the insurance because $1.28 for one strip is really expensive.

Get one of the Wal-Mart meters. You can get a 100ct box of strips for as low as $39.

The fact that some who can afford to pay for healthcare demand government funds and some who truly can't afford healthcare can't be treated.

This thread is full of incomplete sentences, like this, and it's driving me nuts.

Most valuable sentence of this entire thread: Nothing is free.

 

[AntiHouseMD]

This thread is full of incomplete sentences, like this, and it's driving me nuts.

Most valuable sentence of this entire thread: Nothing is free.

Pardon my grammar: "It's the fact that some who can afford healthcare try to cheat the system and some who truly cannot afford healthcare are screwed by the system." I write for a newspaper; I should have caught that.

 

[Web MD]

Doesn't really kill me inside, but coupling insurance to employment should probably change since people aren't sticking with the same job like they were back in the 50's. Also, the fat lady who comes in reeking of cigs that I'm not legally allowed to hit

 

[NickNaylor]

It also kills me that people actually think a socialized system is a viable solution to US healthcare problems.

 

[Web MD]

When you say socialized medicine, are you taking into account the fact tha- wait, wait, I see what you did there. Not this time.........

 

[NickNaylor]

When you say socialized medicine, are you taking into account the fact tha- wait, wait, I see what you did there. Not this time.........

Problem?

 

[Web MD]

Nah, just thought there might be a page of responses to your post steering people away from a ton of other things that piss people off about healthcare.

 

[NickNaylor]

Nah, just thought there might be a page of responses to your post steering people away from a ton of other things that piss people off about healthcare.

The opportunity has still not yet passed...

 

[MeowMeowCAT]

The one thing that bothers me is that after going through all the **** to get your self covered, then make continuous payments, etc. when you actually need to use it you pretty much have to fight them to actually pay for you. They start looking for preexisting conditions, anything to avoid paying for you. I would have assumed that whole point of me paying them was to actually be covered...Don't see why it necessary to always have to prove myself to them that...yes, they still should cover me...That is why I am paying them in the first place rather than paying out of pocket.

 

[startswithb]

Doesn't really kill me inside, but coupling insurance to employment should probably change since people aren't sticking with the same job like they were back in the 50's. Also, the fat lady who comes in reeking of cigs that I'm not legally allowed to hit

Yes. It also puts a HUGE strain on the self-employed and small businesses. My mother ran a company of around 20 employees and once they hired a diabetic everyone's premium went way up. My father is now self-employed and my parents have really crappy really expensive private plans that makes them try to avoid going to the doctor because as soon as they get a treatment for something their rates will go way up again.

 

[Wolfman89]

Yes. It also puts a HUGE strain on the self-employed and small businesses. My mother ran a company of around 20 employees and once they hired a diabetic everyone's premium went way up. My father is now self-employed and my parents have really crappy really expensive private plans that makes them try to avoid going to the doctor because as soon as they get a treatment for something their rates will go way up again.

More to the point it would be illegal (I think) and unethical to boot to discriminate and not higher someone because they have a condition like diabetes, just to keep premiums low.

 

[startswithb]

More to the point it would be illegal (I think) and unethical to boot to discriminate and not higher someone because they have a condition like diabetes, just to keep premiums low.

It is but believe me I'm sure some employers would find another reason not to hire them. It's the sad state of affairs.

 

[krose113]

Anyone read The Healing of America by T.R. Reid?

It's basically a summarized report on the state of health care around the world, focusing on the overall top-rated systems currently operating in France, Germany, Japan, Britain, etc. Reid's thesis is that the U.S. can and should draw lessons from each of the above countries models on a small scale, presumably on the state level, to begin the process. Socialized medicine is stigmatized in this country, but what is so scary about a system that provides universal health care at a reasonable cost using private doctors and hospitals? Buying insurance from a government health plan, with private insurers to cover additional costs, seems logical to me. Aren't we taxed beyond belief anyway?

 

[Wolfman89]

It is but believe me I'm sure some employers would find another reason not to hire them. It's the sad state of affairs.

Yup. I'm not sure what the solution is though.

 

[Hexon]

doctors aren't paid enough for the sacrifice they put into the art

now before ppl start lynching me, let me explain;
sure i love medicine and the sciences as much as everyone else; but i also like comfort and frankly having to be up at crappy hours of the night, the potential health strain that we're looking at once we're in 3rd-4th year or residents requires that we be compensated handsomely;

what's the point of saving lives if we're just ****ing up our own health in the first place, which brings me to my other gripe; the hoops they make you jump through, namely the rite of passage that is being on (beck and) call.
i'm predicting chronic insomnia due to disturbed sleep cycles for more than half of medical students which places them at risk of certain cancers.

 

[NickNaylor]

Anyone read The Healing of America by T.R. Reid?

It's basically a summarized report on the state of health care around the world, focusing on the overall top-rated systems currently operating in France, Germany, Japan, Britain, etc. Reid's thesis is that the U.S. can and should draw lessons from each of the above countries models on a small scale, presumably on the state level, to begin the process. Socialized medicine is stigmatized in this country, but what is so scary about a system that provides universal health care at a reasonable cost using private doctors and hospitals? Buying insurance from a government health plan, with private insurers to cover additional costs, seems logical to me. Aren't we taxed beyond belief anyway?

I agree with you that socialized medicine is stigmatized in the US, but it's also hailed as a holy grail and THE ONLY WAY TO SOLVE THE PROBLEM by many liberals, which is ridiculous. Also, socialized medicine doesn't address the underlying problem of costs. Show me a country with socialized medicine, and I'll show you a trend of ever increasing costs, which will eventually result in increased taxes. Socialized medicine does provide increased coverage and (arguably) increased access, but it won't halt or reduce costs, as evidenced by the European countries that HAVE adopted a socialized model. They still run into budgetary problems, as evidenced by the NHS just a couple of years ago, which was being forced to forgo expanding facilities and laying off/freezing wages for staff.

I also agree with you in that I think the best solution could come from smaller programs run predominantly by the states. I think the idea of states acting as laboratories experimenting with different programs will ultimately result in a solution that will work reasonably well and increase coverage. I doubt this will happen, though, because the federal government wants to have the power to do all of these things. I don't see it just ceding that power to the states willingly.

I think the best solution, though, would be to have both a public and private option. I know this results in the political buzz-phrase of a two-tiered system, but the fact that people complain about that makes me wonder what kind of care a socialized model would provide in the first place. In other words, why do people that advocate for a socialized model complain that a coexistent private system would result in a two-tiered system? What does that say about the public system that would be enacted? If people have the means to pay for more expensive (and more fully featured) private plans, I think they should absolutely have the ability to. People that can't afford that level of coverage will still be able to pay for a cheaper plan that is admittedly not as "luxurious" but will still provide a better level of coverage than what they might be able to afford now. As long as everyone has a baseline level of coverage that won't screw them in emergencies or drop them if they're diagnosed with serious and/or chronic conditions, what's wrong with having different levels of coverage? Individuals that don't use the public option also shouldn't have to pay for the public option. Maybe the government might be able to raise revenue from these "rebels" by taxing private plans at a modest rate.

Also, with respect to tax rates, no we aren't "taxed enough" already (at least historically). In the 50s, income above $250,000 (equivalent to about $2.2 million today) was taxed at a rate of 91-92%. For this past year, income above $373,000 was taxed at a rate of 33%. Tax rates are historically low for all levels of income earners. Unsurprisingly, the size of government has expanded substantially as taxes have been decreased: the annual federal budget in the 50s was around $40 billion, which is equivalent to about $370-400 billion today. Obama's budget for this past fiscal year was $3.7 trillion. Is it any surprise that we are economically screwed? And isn't it somewhat amusing the the economic stimuli passed just a couple of years ago were so large that they could've funded the entire federal government for two years in the 50s (I'm not saying that the stimuli were necessarily wrong - I'll admit I don't have enough knowledge to say one way or another)? I find that incredibly interesting.

I know I got a little off topic at the end there, but the general public's unwillingness to pay for things that it wants from the government - healthcare included - frustrates me to no end.

 

[Wolfman89]

i agree with you that socialized medicine is stigmatized in the us, but it's also hailed as a holy grail and the only way to solve the problem by many liberals, which is ridiculous. Also, socialized medicine doesn't address the underlying problem of costs. Show me a country with socialized medicine, and i'll show you a trend of ever increasing costs, which will eventually result in increased taxes. Socialized medicine does provide increased coverage and (arguably) increased access, but it won't halt or reduce costs, as evidenced by the european countries that have adopted a socialized model. They still run into budgetary problems, as evidenced by the nhs just a couple of years ago, which was being forced to forgo expanding facilities and laying off/freezing wages for staff.

I also agree with you in that i think the ultimate solution will come from smaller programs run predominantly by the states. I think the idea of states acting as laboratories experimenting with different programs will ultimately result in a solution that will work reasonably well and increase coverage. I doubt this will happen, though, because the federal government wants to have the power to do all of these things. I don't see it just ceding that power to the states willingly.

I think the best solution, though, would be to have both a public and private option. I know this results in the political buzz-phrase of a two-tiered system, but the fact that people complain about that makes me wonder what kind of care a socialized model would provide in the first place. In other words, why do people that advocate for a socialized model complain that a coexistent private system would result in a two-tiered system? What does that say about the public system that would be enacted? If people have the means to pay for more expensive (and more fully featured) private plan, i think they should absolutely have the ability to. People that can't afford that level of coverage will still be able to pay for a cheaper plan that is admittedly not as "luxurious" but will still provide a better level of coverage than what they might be able to afford now.

also, with respect to tax rates, no we aren't "taxed enough" already (at least historically). In the 50s, income above $250,000 (equivalent to about $2.2 million today) was taxed at a rate of 91-92%. For this past year, income above $373,000 was taxed at a rate of 33%. Tax rates are historically low for all levels of income earners.

+1000.

 

[HH Holmes]

Ya know what really bothers me? The fact that the surgeon I shadow only has ONE Porsche! What has this world come to where surgeons can only have ONE sports car? Absolutely ridiculous.

 

[FutureDr8429033]

The infiltration of CAM into academic medical centers, and the apathy/ignorance of most physicians regarding its dangers.

 

[BF2BC EMT]

The large illegal immigrant population who are able to go in and out of the hospital system with multiple fake names, not having to pay a dime

 

[Wolfman89]

The large illegal immigrant population who are able to go in and out of the hospital system with multiple fake names, not having to pay a dime

So your solution would be to stop treating all the illegal immigrants? 🙄

I suppose we could round them and deport them all, after all it is not like we are suffering from a severe budget deficit or anything.

 

[krose113]

I agree with you that socialized medicine is stigmatized in the US, but it's also hailed as a holy grail and THE ONLY WAY TO SOLVE THE PROBLEM by many liberals, which is ridiculous. Also, socialized medicine doesn't address the underlying problem of costs. Show me a country with socialized medicine, and I'll show you a trend of ever increasing costs, which will eventually result in increased taxes. Socialized medicine does provide increased coverage and (arguably) increased access, but it won't halt or reduce costs, as evidenced by the European countries that HAVE adopted a socialized model. They still run into budgetary problems, as evidenced by the NHS just a couple of years ago, which was being forced to forgo expanding facilities and laying off/freezing wages for staff.

I also agree with you in that I think the best solution could come from smaller programs run predominantly by the states. I think the idea of states acting as laboratories experimenting with different programs will ultimately result in a solution that will work reasonably well and increase coverage. I doubt this will happen, though, because the federal government wants to have the power to do all of these things. I don't see it just ceding that power to the states willingly.

I think the best solution, though, would be to have both a public and private option. I know this results in the political buzz-phrase of a two-tiered system, but the fact that people complain about that makes me wonder what kind of care a socialized model would provide in the first place. In other words, why do people that advocate for a socialized model complain that a coexistent private system would result in a two-tiered system? What does that say about the public system that would be enacted? If people have the means to pay for more expensive (and more fully featured) private plans, I think they should absolutely have the ability to. People that can't afford that level of coverage will still be able to pay for a cheaper plan that is admittedly not as "luxurious" but will still provide a better level of coverage than what they might be able to afford now. As long as everyone has a baseline level of coverage that won't screw them in emergencies or drop them if they're diagnosed with serious and/or chronic conditions, what's wrong with having different levels of coverage? Individuals that don't use the public option also shouldn't have to pay for the public option. Maybe the government might be able to raise revenue from these "rebels" by taxing private plans at a modest rate.

Also, with respect to tax rates, no we aren't "taxed enough" already (at least historically). In the 50s, income above $250,000 (equivalent to about $2.2 million today) was taxed at a rate of 91-92%. For this past year, income above $373,000 was taxed at a rate of 33%. Tax rates are historically low for all levels of income earners. Unsurprisingly, the size of government has expanded substantially as taxes have been decreased: the annual federal budget in the 50s was around $40 billion, which is equivalent to about $370-400 billion today. Obama's budget for this past fiscal year was $3.7 trillion. Is it any surprise that we are economically screwed? And isn't it somewhat amusing the the economic stimuli passed just a couple of years ago were so large that they could've funded the entire federal government for two years in the 50s (I'm not saying that the stimuli were necessarily wrong - I'll admit I don't have enough knowledge to say one way or another)? I find that incredibly interesting.

I know I got a little off topic at the end there, but the general public's unwillingness to pay for things that it wants from the government - healthcare included - frustrates me to no end.

The words "two-tiered system" are even more deplored in Canada than "socialized medicine" is here in the States, but the Canadian government has enacted certain measures that rule out the possibility of that ever happening. All provinces in Canada make it illegal for patients (and their insurers) to pay privately for any test/Rx/procedure that's covered by the government plan. If you want Viagra, for example, you buy private insurance. I don't mean to suggest that Canada has a model system, the waiting lists are the major drawback, but the statistics show that people who need care get it promptly. Those who don't, wait. Such is reality in a truly egalitarian model, in which fairness is guaranteed by the transparency of the system. It all sounds so idealistic, but when you consider that this type of care is actually in practice, successfully at that, it's astonishing to then go back and assess our current sad state of affairs.

I agree that increasing costs are the major issue that's faced by everyone, "socialized" or not. But health care in government hands has proven to control costs, though not perfectly. That's something I can't really address beyond that, but I'm not aware of anyone who seriously can at this point.

 

[PostHaste]

Let's adjust that a bit:
3. It costs $60K. To make a profit, the surgeon and hospital would like to charge $70K.
4. Surgeon bills insurance for $8000. Hospital bills the insurance for $92,000.
5. Insurance pays the surgeon $4000, who then pays his staff/overhead expenses of $2000, and he takes home $2000 (or less). Insurance then pays the hospital $68,000 of the $92,000 that they billed, which isn't all bad, because that still gives the hospital a reasonable profit. Medicare might not have even paid enough to cover all of the expenses.

Heh, I read this and thought it was way out of line, but here's some back-up to your numbers:
http://www.healthcarebluebook.com/page_Results.aspx?id=29&dataset=hosp
"The Blue Book price is based on the average fee that providers in your area accept as payment from an insurance company for Coronary Artery Bypass Grafting."

Total fair price:
$55k for hospital fees
$3700 for surgeon
$2500 for anesthesiologist

 

[NickNaylor]

The words "two-tiered system" are even more deplored in Canada than "socialized medicine" is here in the States, but the Canadian government has enacted certain measures that rule out the possibility of that ever happening. All provinces in Canada make it illegal for patients (and their insurers) to pay privately for any test/Rx/procedure that's covered by the government plan. If you want Viagra, for example, you buy private insurance. I don't mean to suggest that Canada has a model system, the waiting lists are the major drawback, but the statistics show that people who need care get it promptly. Those who don't, wait. Such is reality in a truly egalitarian model, in which fairness is guaranteed by the transparency of the system. It all sounds so idealistic, but when you consider that this type of care is actually in practice, successfully at that, it's astonishing to then go back and assess our current sad state of affairs.

I agree that increasing costs are the major issue that's faced by everyone, "socialized" or not. But health care in government hands has proven to control costs, though not perfectly. That's something I can't really address beyond that, but I'm not aware of anyone who seriously can at this point.

Socialized care doesn't "control" costs, unless your definition of control is to simply reduce the rate at which costs increase. I guess you could argue that that's better than what we currently have, but the endgame is still the same: costs will eventually reach a point where people simply cannot afford or refuse to pay for services. Why go with a model that is more or less doomed to the same fate? And to prove that I'm not making this up, check out this report, which is produced by an organization that was created by the various levels of Canadian government to make information about the system easily available: http://secure.cihi.ca/cihiweb/products/HCIC_2010_Web_e.pdf Look at figure 28 on p. 93: it's pretty obvious that costs continue to grow exponentially. While the growth as a percentage of GDP is relatively slow, it isn't stopped or reversed. Interestingly, the report states that the largest drivers of healthcare costs are "new drugs, medical technology, medical imaging, costly interventions and community services." None of these are addressed by socialized care unless, of course, you consider unilaterally determining what you're going to pay drug companies for their medications a reasonable solution.

I think there is something fundamentally wrong with the government forcing you to pay for services and items from it as the sole provider. Unless there's some major social change happens in America, you can pretty much kiss any prospect of that happening goodbye. I think most moderate Americans, and certainly not the conservative ones, wouldn't go for that.

I'm not convinced that socialized delivery is everything it's cracked up to be. There's no doubt that, compared to the US, there are advantages. But the problem is by no means solved, and simply adopting a model that really doesn't address the problem seems silly. I don't know how to address the problem, but a socialized model certainly doesn't do it.