why do the uninsured cost us so much money

[Sunfire]

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This is what 'able-bodied' means - can work. You can work, you just choose not to, and instead move away and start school.

My, that really is an irrational statement, isn't it.

You could have easily put a couple of bucks a month toward the bill while you went through school and paid off the rest when you graduated.

I see...a couple of bucks a month? Really? So you're telling me that you know what they told me their minimum payment was? No, seriously, and are you now going to tell me how much money I'll have for food and necessities over the course of my schooling? And when I'll be graduating, and that such a long period of time is acceptable to those who sent me the bills?

Instead you applied for and got this county relief and walked away from the bill that the rest of us will have to eat. Thanks a lot. No, really. It's a real scumbag thing for you to do.

Wow, now you're calling me a "scumbag", for taking state (not county) assistance, considering that I have little means to pay my bill. Remember, we're not talking about someone with assets or substantial funds. I fell well under the requirements for state assistance. What part of that do you not understand?

I hope, that as you go through your medical training and start into a conversation criticising how peope with no insurance waltz into the ED and don't pay a dime, you realize what a HUGE hyprocrite you are.

But you probably won't.

And I hope, that as you go through your medical training, that you learn common decency when speaking with others. You know little to nothing about me or my life. There's a word for holier-than-thou judgmental types such as yourself, but I'm a gentleman and will refrain from using it.

I have no problem with people who qualify for state aid, why in the hell would that bother me? In fact, I expressly asked the worker if there was some way I was taking funds away from those less fortunate. She assured me that the funding was there and that I more than qualified. Would you like to call her, so that you can tell her different?

 

[MOHS_01]

You all do realize that you are trying to argue personal responsibility and accountability with someone from that great bastion of socialistic slant, The Republic of Kalifornia, correct? A self proclaimed Hillary fan? You know, that gloriously insightful individual whose plan was "Medicaid for all"? To hell with the doctors, they will have no choice but to participate when it is mandated?

Really, you would be much better off talking to a post... at least teach your children the concepts of responsibility and accountability... and give up trying to explain anything to the fans of left coast ideologies.

 

[Sunfire]

Wow, so state assistance is a "left coast ideology"? I had no idea. Really, the fact that my ER visit came before my insurance kicked in and while my work hours were low, is a matter of "responsibility and accountability"? How the hell am I supposed to come up with that money, in the timeframe they required, with money that's allotted to me? I'm getting 1500 for a quarter, that's for food and necessities, as well as books and equipment. I'm trying to hold onto the money I have at the moment to try and offset that, as well as to buy a bed and a table and cookware to eat with, not to mention the food I have to buy before my loan refund comes.

Honestly, with that kind of insulting pablum, MOHS_01, it's too bad the bill couldn't have been taken directly from your own wallet. You'd deserve that for feeling you have the right to speak so rudely towards others.

ANY OTHER SNOTTY RESIDENTS OR UPPITY DOCTORS WANT TO ATTACK ME FOR TAKING STATE ASSISTANCE FOR A BILL THAT I WOULD HAVE HAD TROUBLE PAYING? ANY OTHER INSULTS OR STRIKES ANYONE WANTS TO PULL ON SOMEONE WHO QUALIFIED FOR HELP?

 

[MOHS_01]

Wow, so state assistance is a "left coast ideology"? I had no idea.

To the extent that "State assistance" has blossomed, yes, it can very much be considered a leftist ideology. So now you do...

Really, the fact that my ER visit came before my insurance kicked in and while my work hours were low, is a matter of "responsibility and accountability"? How the hell am I supposed to come up with that money, in the timeframe they required, with money that's allotted to me? I'm getting 1500 for a quarter, that's for food and necessities, as well as books and equipment. I'm trying to hold onto the money I have at the moment to try and offset that, as well as to buy a bed and a table and cookware to eat with, not to mention the food I have to buy before my loan refund comes.

Friend, no one disparages you for your current financial situation -- for we have all been students at some point in our lives. Likewise, I believe that everyone on here understands that medical bills, especially ER bills, are greatly inflated, and should NOT be paid at face value. Where the problem comes in is coming on here and stating that "it was taken care of by the state (which has no money in and of itself; it is only afforded money by taking it from the productive members of society) and I won't owe anything". This thought process is fundamentally flawed and is the reason for the generated ire.

Honestly, with that kind of insulting pablum, MOHS_01, it's too bad the bill couldn't have been taken directly from your own wallet. You'd deserve that for feeling you have the right to speak so rudely towards others.

ANY OTHER SNOTTY RESIDENTS OR UPPITY DOCTORS WANT TO ATTACK ME FOR TAKING STATE ASSISTANCE FOR A BILL THAT I WOULD HAVE HAD TROUBLE PAYING? ANY OTHER INSULTS OR STRIKES ANYONE WANTS TO PULL ON SOMEONE WHO QUALIFIED FOR HELP?

Don't worry buddy, you can sleep tight tonight for I support many, many governmental socialistic programs with my tax dollars.

"Rude" would be a blatantly personal attack, which this is not -- it always was a commentary on the fundamental flaws associated with this line of thinking.

 

[dpmd]

I think some of the animosity towards sunfire's statment about getting assistance that now means he does not have to pay any of the bill comes from those of us who have seen this kind of thing abused. I have had plenty of people who don't make a whole lot, and therefore qualify for assistance, who could probably avoid the need for public assistance with a change in their priorities. People who could probably afford health coverage if they cancelled their cell phone and did not purchase the latest trendy clothing. I remember in medical school they had a patient come in to talk about their experience with some medical condition and they talked about how they were on medi-cal in the same breath they talked about watching their direct TV. All I could think about was how I don't have direct TV, because it wouldn't fit in to my budget in school (or during the period of time I was in between schools and paid for COBRA coverage and other necessities by working my ass off and cutting out stuff like eating out, cable, phone, and reducing my rent by renting a room instead of a whole apartment).

I'm not saying anything about the specifics of sunfire's life, because I don't know what sort of choices were made when allowing the lapse in health insurance. However, think about what that does to incentives. Maybe I should have lived life better and relied on the fact that state assistance could bail me out if I got sick? That is the sort of thing that bothers me.

 

[Sunfire]

dpmd, what you say makes sense. I graduated from my undergrad university in March, and my coverage stopped then. Coverage from my new school didn't start until Sept. Unfortunately, my ER visit was in July. I don't know if I mentioned that I had offered to pay a smaller amount, but that it was an all or none deal with the agency. The case worker said I'd be surprised how many people ask when they can pay the aid back. The only payback requirement is if I ever own and sell property, then the amount of the bill will automatically be taken from that.

I mentioned to her the type of responses I received here. At first she was shocked, the word "scumbag" put her into silence. She thought for a few seconds and then told me that there was a time in her life when she needed similar help. Her opinion then and now was that she had given to the system her entire life, and she was thankful that the system was there when she needed it. She again assured me that I qualified (or else I wouldn't have been granted the aid) and told me that the only thing I needed to worry about was a safe trip.

I am equally thankful that the assistance was there when I needed it. I don't have a cell phone, and don't live extravagantly. I've been staying with friends who have helped me in preparing, mainly by giving me low rent so that I could save in order to be able to have money for necessities upon arrival. After all is said and done, I am leaving with 500 to my name and I'll do my best to make it stretch (used furniture stores, etc).

I've learned a few lessons here. One was what I already knew, that people who don't understand what it means to seriously struggle financially are simply what they are and more can't be asked of them at this point in their lives. Two, it's dangerous territory to put details of your personal life in front of strangers, because oftentimes they're scavengers who will prey on your weaknesses without any regard to your thoughts and feelings. The third lesson, and the most important, is that the government was there when I needed help. I hope that others in similar situations can experience the same type of relief as did I.

 

[drelizabeth292]

dpmd, what you say makes sense. I graduated from my undergrad university in March, and my coverage stopped then. Coverage from my new school didn't start until Sept. Unfortunately, my ER visit was in July. I don't know if I mentioned that I had offered to pay a smaller amount, but that it was an all or none deal with the agency. The case worker said I'd be surprised how many people ask when they can pay the aid back. The only payback requirement is if I ever own and sell property, then the amount of the bill will automatically be taken from that.

I mentioned to her the type of responses I received here. At first she was shocked, the word "scumbag" put her into silence. She thought for a few seconds and then told me that there was a time in her life when she needed similar help. Her opinion then and now was that she had given to the system her entire life, and she was thankful that the system was there when she needed it. She again assured me that I qualified (or else I wouldn't have been granted the aid) and told me that the only thing I needed to worry about was a safe trip.

I am equally thankful that the assistance was there when I needed it. I don't have a cell phone, and don't live extravagantly. I've been staying with friends who have helped me in preparing, mainly by giving me low rent so that I could save in order to be able to have money for necessities upon arrival. After all is said and done, I am leaving with 500 to my name and I'll do my best to make it stretch (used furniture stores, etc).

I've learned a few lessons here. One was what I already knew, that people who don't understand what it means to seriously struggle financially are simply what they are and more can't be asked of them at this point in their lives. Two, it's dangerous territory to put details of your personal life in front of strangers, because oftentimes they're scavengers who will prey on your weaknesses without any regard to your thoughts and feelings. The third lesson, and the most important, is that the government was there when I needed help. I hope that others in similar situations can experience the same type of relief as did I.

nicely put.👍

 

[michaelrack]

And as my macroeconomics prof says, in an post-industrial society, our most valuable asset is human capital.

A lot of assets are dropping in value these days.

 

[MOHS_01]

.

 

[Tired]

My gut feeling is that those who develop the most ire around topics like this are not those who were born with a silver spoon in their mouth -- it is those who came from little, borrowed and worked a lot, and tried to get ahead only to find a monumental governmental anchor strapped to their back impeding their efforts.

I think about all the months I paid the COBRA premium to maintain insurance between schools and jobs, and I get a little ill with this story.

 

[moveon1]

No. Docs don't get paid to do nothing. The vast majority of docs make their money by billing patients for services. It's a small minority who get a salary from a hospital. That includes all specialties, not just EM.

It's not the long hours that drive up costs. Talking about ED staffing, and therefore we're really talking about nursing, it's cheaper to staff 1 person for 12 hour shifts than 1.3 people for 8 hour shifts. That's one of the main components of the high bill and it doesn't include the doc's bill (interestingly doc billing is largely independent of hours). Most ED nurses are critical care level capable and are expensive. The "nurse" at a clinic where the patient should be for their ear ache is probably a min wage medical assistant.

One way to look at it is that the system expects people to triage themselves based on the costs. They shouldn't go to the ED for their ear ache. Since few people pay their bills themselves, the insured have insurance and the uninsured don't pay, that cost triage has failed.

When you go to the ED for your earache you are paying for the capability of the team there to code you should you turn out to have a real emergency, that means staff, training and equipment (not to mention liability, infrastructure, drugs, etc.). That's why it costs so much.

There is a long thread on ER costs and use by medicaid/uninsured patients. I am wondering about a solution and interested in feedback particularly from physicians who are familiar with hospital structure/policy, ER's and outpatient clinics. (In know that covers a lot, but I hope this will make sense).

I currently work with people transitioning out of homelessness. I am beginning a program to teach these patients standard "medical competencies" a patient "job training," if you will. The goal would be to have these patients become more competent and adept in their own health care management. These clients work towards a form of certification (i.e. some form of testing) regarding their health-care-related skills. Ideally the result would then be an uninsured population of patients that were better educated and knew better than to "just go" to the ER.

I would like to provide patients and hospitals an incentive for supporting/ this program. I am wondering if I can convince a hospital to allow these patients into an outpatient clinic that would not otherwise be accessible. This would mean a cost saving because these patients now no longer need to go to the ER. It would also be incentive for patients to become certified, because they now have a regular doctor at an outpatient clinic.

It's a preliminary idea, but your thoughts are appreciated.

 

[rickevans033050]

Ok, so people always say how the uninsured cost us money. I realize this is a "stupid question" but i'd like someone to explain it to me in real terms.

How exactly do they cost us money, because if you assume they are uninsured because they can't pay, then gov't will be paying either way. Either for their insurance or their hospital bill.

The claim that the uninsured cost us money is a misleading narrative repeated by certain activists and lobbyists and parroted by the news media.

Some love to argue that the uninsured show don't get primary care, then show up at the emergency room where the rates are higher. However in the U.S. mothers with medicaid are insured and still have a habit of showing up at the ER towing a kid with a sore throat. Why? Unlike when I was growing up there are few family doctors in the nabe. CVS pharmacy is introducing minute clinics staffed by nurse practitioners over the fierce opposition of doctors and hospitals who don't want the competition for those uninsured patients. Hmm.

Hospitals in the U.S. routinely bill uninsured patients at rates two or three times the rates paid by insurers. A lot of those patients you hear about going bankrupt on credit card debt are ones who made an earnest effort to pay a medical bill. In this case the "providers" are profiteering off of the uninsured. In fact an emerging profession for nurse practitioners and former health insurance workers is the patient advocate who often successfully degotiates a big reduction in those patient gouging bills.

Some advocates argue that the uninsured raise premiums by using the health care system and failing to pay. Perhaps. However what also drives up premiums is health care inflation which is driven by demand and the increasing use of expensive procedures and drugs used on insured patients! The biggest group of insured high use health care consumers are old retirees with medicare.

Two years ago Massachusetts sent the media into a fawning frenzy when it made it a requirement to have health insurance in Massachusetts. Large numbers of previously uninsured ER users still use the ER. Why? There's a shortage of primary care docs in Massachusetts; especially in the Western part of the state. Also, insurance premiums continue to rise in double digits. The state claims 97% of residents are now insured. I guess that uninsured 3% carries a lot of leverage.

 

[psy]

Some love to argue that the uninsured show don't get primary care, then show up at the emergency room where the rates are higher.

Well yes...if you are uninsured you usually don't have a primary care doctor.

However in the U.S. mothers with medicaid are insured and still have a habit of showing up at the ER towing a kid with a sore throat. Why? Unlike when I was growing up there are few family doctors in the nabe. CVS pharmacy is introducing minute clinics staffed by nurse practitioners over the fierce opposition of doctors and hospitals who don't want the competition for those uninsured patients. Hmm.

Ok, so how many of these mothers are out there? I agree there is a family doctor shortage in certain areas. However, how did you come up with the idea that hospitals are in competition over UNINSURED patients? I thought you needed insurance go to these nurse practitioners in those minute clinics.

Hospitals in the U.S. routinely bill uninsured patients at rates two or three times the rates paid by insurers. A lot of those patients you hear about going bankrupt on credit card debt are ones who made an earnest effort to pay a medical bill. In this case the "providers" are profiteering off of the uninsured. In fact an emerging profession for nurse practitioners and former health insurance workers is the patient advocate who often successfully degotiates a big reduction in those patient gouging bills.

Ok...this reeks of advertisement...are you a nurse practioner by any chance? I'm not familiar with the rates hospital charges but I find it hard to believe they are at 2x to 3x the price they charge regularly insured patients [citation needed]. You refer to emerging nurse practioners who advocate lower costs for patients yet I've read a other threads refering to these same nurse practioners advocating for EQUAL reimbursements with doctors. How is that reducing cost?

Some advocates argue that the uninsured raise premiums by using the health care system and failing to pay. Perhaps. However what also drives up premiums is health care inflation which is driven by demand and the increasing use of expensive procedures and drugs used on insured patients! The biggest group of insured high use health care consumers are old retirees with medicare.

So you are saying the fault should also lie with those pesky insured old people who demands quality care to keep them alive and moving.

Two years ago Massachusetts sent the media into a fawning frenzy when it made it a requirement to have health insurance in Massachusetts. Large numbers of previously uninsured ER users still use the ER. Why? There's a shortage of primary care docs in Massachusetts; especially in the Western part of the state. Also, insurance premiums continue to rise in double digits. The state claims 97% of residents are now insured. I guess that uninsured 3% carries a lot of leverage.

I'm not familiar with the insurance system but does increase premium correlates with increase healthcare cost? You also point out that there is a shortage of primary care doctors. Maybe the solution would be to encourage more primary care physicians by not cutting their wages further and ease their work load.

 

[Miami_med]

Well yes...if you are uninsured you usually don't have a primary care doctor.


Ok, so how many of these mothers are out there? I agree there is a family doctor shortage in certain areas. However, how did you come up with the idea that hospitals are in competition over UNINSURED patients? I thought you needed insurance go to these nurse practitioners in those minute clinics.



Ok...this reeks of advertisement...are you a nurse practioner by any chance? I'm not familiar with the rates hospital charges but I find it hard to believe they are at 2x to 3x the price they charge regularly insured patients [citation needed]. You refer to emerging nurse practioners who advocate lower costs for patients yet I've read a other threads refering to these same nurse practioners advocating for EQUAL reimbursements with doctors. How is that reducing cost?



So you are saying the fault should also lie with those pesky insured old people who demands quality care to keep them alive and moving.



I'm not familiar with the insurance system but does increase premium correlates with increase healthcare cost? You also point out that there is a shortage of primary care doctors. Maybe the solution would be to encourage more primary care physicians by not cutting their wages further and ease their work load.

rickevans is actually largely correct. What happened was this: Insurance companies used to negotiate rates as a percentage of physician fees, and physicians thus raised fees in order to collect what they wanted. If you get paid 50%, you charge twice as much to get the same amount of money. Of course, the uninsured now have twice the bill to pay. Most hospitals and physicians have no intention of collecting this amount, and most uninsured individuals can negotiate. However, it is FRAUD under current law to not bill your full rate to the uninsured. Current law works AGAINST the uninsured.

Increased premiums DO correlate in large part with increased costs. Those costs are largely driven by the 800 lbs gorrilla in the room, the malpractice problem.

 

[rickevans033050]

Well yes...if you are uninsured you usually don't have a primary care doctor.

Lots of insured patients lack a primary care doctor. In Massachusetts there is cuurrently a shortage exacerbated by the states recent mandatory health insurance law. http://www.thebostonchannel.com/health/17645872/detail.html

When I was in my 20s in the '70s I was uninsured but had a primary care doc who I paid cash. He was an older guy with a neighborhood practice and affiliation with local hospitals.

I agree there is a family doctor shortage in certain areas. However, how did you come up with the idea that hospitals are in competition over UNINSURED patients? I thought you needed insurance go to these nurse practitioners in those minute clinics.

And you would be wrong. They clinics have a set fee schedule and take cash credit cards or insurance.

Ok...this reeks of advertisement

Olfactory hallucination perhaps?

...are you a nurse practioner by any chance?

Nope, not even a nurse or doctor. Nice try at personalization though.😉

I'm not familiar with the rates hospital charges but I find it hard to believe they are at 2x to 3x the price they charge regularly insured patients [citation needed].

http://www.pbs.org/newshour/updates/health/jan-june07/uninsured_05-10.html

http://www.jhsph.edu/publichealthnews/press_releases/2007/anderson_hospital_charges.html

http://www.msnbc.msn.com/id/5290172/

You refer to emerging nurse practioners who advocate lower costs for patients yet I've read a other threads refering to these same nurse practioners advocating for EQUAL reimbursements with doctors. How is that reducing cost?

Please re-read what I wrote. I referred to an emerging profession of patient advocates who negotiate lower bills for patients for a fee. Some of these advocates also formally worked in the insurance industry or in human resources along with former nurse practitioners .

In fact I consider nurses organizations part of the problem. When I was in grad school in the '70s school teaching nursing students professional nursing organizations were seeking ways to reduce the number of new nurses to ease a "surplus". They even pushed for our chemistry department to toughen up our courses to reduce the number of qualifiers. They also sought to shrink the number of nurses by requiring older nurses get B.S. degrees.

So you are saying the fault should also lie with those pesky insured old people who demands quality care to keep them alive and moving.

Nice emotionalism try. I simply stated a fact. Medicare spending is a fast growing health care inflation driver. My point was that with insurance are the big health care consumers and their demand is what drives health care inflation. The fault lies in the fee for service model which rewards the use of procedures regardless of the efficacy relative to other approaches; at least according to Boston University economist Laurence Kotlikoff. He advocates a form of age/health history adjusted tax credit/voucher for buying insurance as a way holding down health care inflation.

I'm not familiar with the insurance system but does increase premium correlates with increase health care cost?

Of course it does. What is called health insurance today is really equivalent to having car insurance pay for your car maintenance along with protecting you against accidents or theft. Insurers are little more than profiteering paper shuffling bill paying middle (wo)men.

You also point out that there is a shortage of primary care doctors. Maybe the solution would be to encourage more primary care physicians by not cutting their wages further and ease their work load.

I agree. We definitely need to stop over compensating specialists and redistribute some of that wealth to their lower paid colleagues.

 

[dpmd]

We definitely need to stop over compensating specialists and redistribute some of that wealth to their lower paid colleagues.

Why do you believe that extra pay for extra expertise is "over compensation", and in what way would a redistribution of wealth amongst physicians address the problem of health care costs in general?

 

[FLDoc]

Could someone more experienced/knowledgeable than I spend a few minutes dicussing the cost benefits of preventitive medicine.

In my view, our health care system is setup to bandage badly broken machines for large sums of money instead of oiling the bright shiny ones a couple times a year for pennies.

Lets take hypertension and heart disease. If everyone had access to care and physicians were able to treat those who are currently uninsured (and therefore undiagnosed) with cost effective diaretics and ACE inhibitors, wouldn't we save 1000s in ED and cathlab fees when they dont show up for there first cardiac infarction at 50?

Maybe its a pipe dream to think that ppl, if given the opportunity and the knowledge (education is key) to live a healthier life, would take madicine that is prescribed and show up for reasonably priced office visits to monitor their progress.

please let me know what you think

 

[nsx]

ppl, if given the opportunity and the knowledge (education is key) to live a healthier life, would take madicine that is prescribed and show up for reasonably priced office visits to monitor their progress.

Not gonna happen 😀
But this might be seen as job security if you're an interventionist.

 

[Miami_med]

Could someone more experienced/knowledgeable than I spend a few minutes dicussing the cost benefits of preventitive medicine.

In my view, our health care system is setup to bandage badly broken machines for large sums of money instead of oiling the bright shiny ones a couple times a year for pennies.

Lets take hypertension and heart disease. If everyone had access to care and physicians were able to treat those who are currently uninsured (and therefore undiagnosed) with cost effective diaretics and ACE inhibitors, wouldn't we save 1000s in ED and cathlab fees when they dont show up for there first cardiac infarction at 50?

Maybe its a pipe dream to think that ppl, if given the opportunity and the knowledge (education is key) to live a healthier life, would take madicine that is prescribed and show up for reasonably priced office visits to monitor their progress.

please let me know what you think

Yes and no. It is clearly better for the patients to be treated, but from a purely financial point of view, the delay of MIs or strokes may actually raise healthcare costs, as these people will have more years of follow-up before they finally get hit with the big disaster that inevitably strikes us all, no matter how healthy.

 

[group_theory]

Could someone more experienced/knowledgeable than I spend a few minutes dicussing the cost benefits of preventitive medicine.

In my view, our health care system is setup to bandage badly broken machines for large sums of money instead of oiling the bright shiny ones a couple times a year for pennies.

Lets take hypertension and heart disease. If everyone had access to care and physicians were able to treat those who are currently uninsured (and therefore undiagnosed) with cost effective diaretics and ACE inhibitors, wouldn't we save 1000s in ED and cathlab fees when they dont show up for there first cardiac infarction at 50?

Maybe its a pipe dream to think that ppl, if given the opportunity and the knowledge (education is key) to live a healthier life, would take madicine that is prescribed and show up for reasonably priced office visits to monitor their progress.

please let me know what you think

mortality rate of life reaches 100% eventually. There is nothing that doctors can do to reduce that percentage. It's a delay game. Even if you are healthy, without hypertension or high cholesterol, you will eventually die one day. The problem is that no one wants to die. No one wants their family member to die. So when a diaster hits (sepsis in a 70 year old with Alzheimer) ... you will want everything done (since it is not obvious at this point that it is futile care). Perhaps a brief stay in the ICU for respiratory distress and hypotension. Then a week or two on the medicine floor. Then a couple weeks to month in acute rehab (or subacute rehab). Then perhaps placement in a nursing home (or if with family members at home with visiting nurses, etc).

Guess how much it will cost to provide that care. But let's say you have insurance (personal, government, or universal). The cost of that care is passed along into the big pool. The problem with this business model is that eventually everyone will need to dip into the big pool - and as you age, you will dip into the big pool more often. If you live long enough, you will eventually spend more healthcare dollars in your lifetime than you contribute. If enough people live long enough, then it bankrupts the system.

The irony is that sudden early deaths actually reduces cost. If you were to have a massive heart attack and die at the age of 65 - you just gave the healthcare system a net positive balance. You contributed into the system and barely took any of it out. But if you were to survive that heart attack - the medications, along with doctors visits, and eventual hospitalizations for other stuff ... you will end up taking more healthcare dollars out than you put in.


A large percentage of healthcare expenses come at the end of life. To quote a study by Luce and Rubenfeld from UCSF and University of Washington respectively:

"6% of Medicare recipients 65 yr of age and older who died in 1978 and 1988 accounted for 28% of all costs of the Medicare program. In the same two years, 77% of the Medicare decedents' expenditures occurred in the last year of life, 52% of them in the last 2 mo, and 40% in the last month. Inpatient expenses accounted for over 70% of the decedents' total costs"
http://ajrccm.atsjournals.org/cgi/content/full/165/6/750

additional sources:
Lubitz J, Prihoda R. The use and costs of Medicare services in the last 2 years of life. Health Care Financing Rev 1984; 5: 117-131

Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med 1993; 328: 1092-1096 http://ajrccm.atsjournals.org/cgi/ijlink?linkType=ABST&journalCode=nejm&resid=328/15/1092

 

[rickevans033050]

Why do you believe that extra pay for extra expertise is "over compensation", and in what way would a redistribution of wealth amongst physicians address the problem of health care costs in general?

Because whenever the shortage of primary care docs is brought up the first reason med students cite is the low compensation of primary care doctors. Doctors in general then call for higher pay for primary care doctors which does nothing more than raise the entire medical compensation scale.That simply drives up health care costs. There is no constituency in the medical industry to reign in costs. I frankly tossed that comment out as more of a barb than a realistic proposal.

 

[Miami_med]

Because whenever the shortage of primary care docs is brought up the first reason med students cite is the low compensation of primary care doctors. Doctors in general then call for higher pay for primary care doctors which does nothing more than raise the entire medical compensation scale.That simply drives up health care costs. There is no constituency in the medical industry to reign in costs. I frankly tossed that comment out as more of a barb than a realistic proposal.

Since the "medical compensation scale" has failed to keep up with inflation for about the last decade, I hardly believe that this can be blamed for the driving up of healthcare costs. More patients perhaps, better hospital compensation possibly, more tests almost assuredly, but the pay for the same work to the physician is consistently in decline across the board.

In a market in which third party payers didn't control everything, I suspect that specialists would still be paid more, but there would be much fewer of them, as people would stick with the primary physician that they know and who is being paid cash. A cardiology consult over every murmur would probably go away if every 20 year old has to pay out of pocket the money for the consult and the echo to diagnose MVP. It is clear that a specialist could and pobably should collect more for doing the same procedure or the same diagnostic evaluation. This higher cost in a free market however, will repel some people to seek price savings with the generalist. This gives the generalist a somewhat lower pound for pound income potential, but it makes it much easier to build a practice and become successful because you're not boxed in.

 

[8744]

I doubt it. Most people don't want to take an ambulance or go to the ED if it's not necessary. Going to our ED with a head cold will cost you 6++ hours in a waiting room chair most days. If a patient had the option to go to a primary care office for little or no cost, he would take it.

No. You are wrong. To see a primary care doctor requires a patient to make a phone call, make an appointment, keep the appointment, and provide transportation for himself. This will easily take a substantial chunk out of the day not to mention the wait in the doctor's office. It is far, far easier to call an ambulance and wait in the Emergency Department, an activity that costs nothing but a simple call to 911.

As for the wait, sometimes the wait in the ED isn't that long and in newer departments, they try to at least get you into a room in thirty minutes where you can watch a nice flat-screen TV while resting on a more-or-less comfortable ED bed.

Additionally, the ED is more likely to provide the work-up that a patient thinks he deserves. If you need lab work, it is not uncommon for a PCP to send you to a lab outside of his office and you will not get the results for a few days which may require another visit to your PCP. In the ED you can get the results of everything during that same visit.

Not to mention that a substantial percentage of the Holy Underserved are lazy, stupid, and supremely entitled. I have had patients call ambulances for things so trivial (a small rash on the arm, a small cut requiring no repair) that they should be prosecuted for inappropriate use of Emergency Services.

 

[45408]

I doubt it. Most people don't want to take an ambulance or go to the ED if it's not necessary. Going to our ED with a head cold will cost you 6++ hours in a waiting room chair most days. If a patient had the option to go to a primary care office for little or no cost, he would take it.

Nah, they'd call 911. I've taken people to the ER for hangovers, headaches, stomach aches, anything. Doesn't matter how minor. Try working on an ambulance sometime, and you'll see just how trivial these things can get. Besides, the doctor's office won't come pick you up within 5 minutes of your call.


And time? These people have more time than anything else.

 

[deleted87716]

it is FRAUD under current law to not bill your full rate to the uninsured.

Incorrect. While you cannot have multiple fee schedules, you can offer cash-paying patients a discount. The usual stipulation is that they must pay in full at the time of service in order to receive the discount.

 

[deleted87716]

Could someone more experienced/knowledgeable than I spend a few minutes dicussing the cost benefits of preventitive medicine.

See: http://www.aafp.org/online/en/home/policy/familymedvalue.html

or: http://www.acponline.org/advocacy/where_we_stand/policy/primary_shortage.pdf

 

[deleted87716]

Because whenever the shortage of primary care docs is brought up the first reason med students cite is the low compensation of primary care doctors. Doctors in general then call for higher pay for primary care doctors which does nothing more than raise the entire medical compensation scale.That simply drives up health care costs.

It also removes one of the main obstacles to choosing a career in primary care.

Furthermore, most of the proposals currently on the table are budget-neutral. We all know what that means.

 

[radslooking]

No. You are wrong. To see a primary care doctor requires a patient to make a phone call, make an appointment, keep the appointment, and provide transportation for himself. This will easily take a substantial chunk out of the day not to mention the wait in the doctor's office. It is far, far easier to call an ambulance and wait in the Emergency Department, an activity that costs nothing but a simple call to 911.

As for the wait, sometimes the wait in the ED isn't that long and in newer departments, they try to at least get you into a room in thirty minutes where you can watch a nice flat-screen TV while resting on a more-or-less comfortable ED bed.

Additionally, the ED is more likely to provide the work-up that a patient thinks he deserves. If you need lab work, it is not uncommon for a PCP to send you to a lab outside of his office and you will not get the results for a few days which may require another visit to your PCP. In the ED you can get the results of everything during that same visit.

Not to mention that a substantial percentage of the Holy Underserved are lazy, stupid, and supremely entitled. I have had patients call ambulances for things so trivial (a small rash on the arm, a small cut requiring no repair) that they should be prosecuted for inappropriate use of Emergency Services.

i'd agree with that. im not sure what the whole solution to it is, but i certainly agree with the suppositions.