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from the there-should-be-an-app-for-that dept.
Fountain Valley resident Jennifer Moore makes a really good point.
"When you take your car to the mechanic, they give you a written estimate before they touch it," she told me.
"So why is it that when you go to the hospital, you have no idea how much something will cost until the bill arrives?"
Moreover, why are prices so completely different from one healthcare provider to another?
And why is it that when patients try to find out in advance how much something will cost, they're treated like unwelcome guests rather than equal partners in their own treatment?
[...] The near-total lack of transparency in healthcare pricing is a key reason we have the highest costs in the world — roughly twice what people in other developed countries pay.
Simply put, drugmakers, hospitals, labs and other medical providers face no accountability for their frequently obscene charges because it's often impossible for patients to know how badly they're being ripped off.
[...] Moore's insurer, Cigna, was charged $2,758 by the medical center for the two ultrasounds. However, Cigna gets a contractual discount of just over $1,000 because it's, well, Cigna. All insurers cut such sweetheart deals with medical providers.
That lowered the bill to $1,739. Cigna paid $500. That left a balance of $1,239, for which Mika was entirely responsible because she hadn't met her $1,250 deductible for the year.
Moore quickly ascertained online that the average cost for a pair of ultrasounds is about $500 — meaning the medical center's original $2,758 charge represented a more than 400% markup.
Cigna's lower contractual charge of $1,739 still meant the bill had been marked up more than 200%.
And the $1,239 Mika had to pay was more than twice the national average.
Wait, it gets even worse.
Moore said that after working her way through various levels of customer service in the medical center's billing department, she learned that the cash price for the two ultrasounds was $521.
https://www.latimes.com/business/story/2019-07-29/column-could-our-healthcare-system-be-any-dumber
(Score: 1, Informative) by Anonymous Coward on Saturday August 03 2019, @02:02AM
Agree. Stop it!
(Score: 2, Insightful) by Anonymous Coward on Saturday August 03 2019, @02:07AM (10 children)
Insurance doesn't magically fix supply and demand problems. News at 11.
(Score: 2) by c0lo on Saturday August 03 2019, @03:00AM
>blockquote>Insurance doesn't magically fix supply and demand problems.
Is it insurance or an intermediary, though? Even more, an intermediary which, by its behaviour and existence (think "a big pool of money the insured never controls"), alters the supply/demand equation.
Sorta the compromise that compromises everything - neither public health (fully regulated), nor self-insurance (personal responsibility - i.e each setting aside money for the rainy days)
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 5, Insightful) by ikanreed on Saturday August 03 2019, @03:52AM (1 child)
You think medical care pricing has anything to do with the abstract idea of "supply and demand", rather than scummy executives calculating what price they can get away with when "Grandma's on the table" [commondreams.org]
For profit healthcare makes as much sense as for-profit policing or for-profit military.
(Score: 3, Interesting) by JoeMerchant on Saturday August 03 2019, @05:49PM
Or for-profit prisons, or fire control, or allowing the ex-tobacco industry to dominate the retail grocery supply chain.
Good business is where you find it, for as long as you can get away with it, and when it grows to the proportion of for-profit basic healthcare - you may as well be negotiating with the coast guard when they are pulling you off a sinking ship in stormy seas...
What if, in addition to taxes, businesses had to report their human impact: number of jobs provided, income paid to those employees, actual (leaving home until returning home) time worked by those employees, working conditions for those employees (life safety, health safety, stress), and their impact on their customers: how are they helping people in the world? And their suppliers, and their environmental impact. Collect that baseline data for 4 years, then spend the next 4 years hammering out tax incentives based on business impact.
Want to charge $3500 per dose for Epi-pens? Sure, you can do that, but your negative quality of life impact on your customers (the ones dying because they can't afford a product that's cheap to make) should result in an increased $2000 per dose tax - which can be provided to a competitor as an incentive to give generic Epi-pens away for free.
🌻🌻 [google.com]
(Score: 3, Interesting) by Runaway1956 on Saturday August 03 2019, @02:13PM (6 children)
Quite the opposite. Third party insurers, whether they be government, or private, drive prices UP. That's the whole idea of having a middleman. The middleman makes connections for you, while charging you for the privilege. That much should be obvious to all of us, no matter our age, sophistication, intelligence, or whatever. Middlemen drive prices up.
To make things worse, the vendors are milking the system. Sometimes, they remain barely legal, sometimes, they just don't care about legality. They know how the system works, so they milk it as hard as they can. You, who only get wrapped into the system now and then, are always the victim.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @07:00PM (2 children)
What ticks me off is they do not get this.
Adding more middle man, AND gobs more money, and hid all the prices that drove up prices. They like to pretend economics does not exist for them at all.
Then they want to pretend my insurance rates have nearly 100x from the early 90s. If I was paying what I did now for insurance in the 90s I would have 0 co-pay and walk into any place i wanted and they would have covered it. Now I have huge deductibles and about 1/4th the choice I used to have. I know what the insurance rates for the early 90s were too as I worked as a clerk in an insurance firm that sold it. Many of the customers I typed in data for were at MOST 200 bucks a year. These were people in their 80s!
Hillarycare made us have to get a job to have the 'good insurance'. Obamacare put the top onto that and made it so I paid 10x. Now they stand in front of me saying they can fix this shit. They make it worse every time!
I can walk into a place and say 'i will pay cash, today, right now' and almost every single time the price drops from something ridiculous like 5000 dollars to 200 bucks. Even 200 bucks is 'too much' usually.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:09AM (1 child)
Had Obamacare included a public option, we likely wouldn't be seeing the continued increase in premiums that we're seeing. Last time I checked, the rate increases had somewhat slowed, but not by enough.
The other issue though is the GOP's continued efforts to undermine the law at every opportunity. Between that and the lack of a public option, the only real choice here is to continue to push for single payer, medicare for all solutions to end the problem forever. I'm not surprised that the GOP is fighting this so hard, having guaranteed medical care available to everybody would greatly weaken the hold that employers have over employees. As well as demonstrating that the government does do somethings better than the private sector.
The worst thing though is that while most people in all parties support the idea, you can't even get most Democrats on board with the importance of real reform to the system. They keep talking about incremental change knowing full well that that means each change will be hard fought and most voters are more concerned with their access and how that will change. Medicare for all is an easy argument to make. Even my former roommate whose father suffered some malpractice in the UK still wouldn't give up the NIH system for what we have in the US.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:20PM
My sources say that ACA stopped being a problem to major insurers right at the time they got out of the marketplace plans because they weren't making enough money.
You know, when suddenly the priority became that the ACA had to go, and miraculously the individual mandate was repealed.
That the ACA is costing the mainline insurers money (money, not potential insureds getting it for cheaper) is a nice fat lie at this point.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @01:26AM
And yet single-payer healthcare systems and other forms of universal healthcare systems are substantially cheaper and higher quality for the average person than our own for-profit private death panel system.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @05:15AM
methinks in healthcare these days, the actual patient isn't the customer, but just another product. All the health monitoring, genetic analyses, the patient's medical records, all fodder. any outcomes, are just coincidental.
In many ways now the actual care givers are also just another product.
the amount of info now captured in medical IT and insurance systems is pretty staggering.
(Score: 2) by dry on Sunday August 04 2019, @06:03AM
The prices are controlled by the government, after negotiations with the Doctors, here in BC. An MMR costs X (probably a couple of hundred dollars), even for the uninsured. Makes the accounting so simple that the cost savings more then make up for the lower payments.
Things that aren't covered are advertised. I go into any Doctors office and there is a list of prices on the wall. Need a medical for driving license or such, it's a hundred bucks or so.
The flaw is overuse, people going to emergency for a snivel and such, which does raise the expenses and causes delays.
It's not perfect, but everyone I know who needed surgery or such now, got it within 24 hours and usually less if they avoided needing it on Sunday.
Elective stuff and non-life threatening stuff can be slow as well and every Province is a bit different, healthcare is a Provincial responsibility in Canada with the feds shuffling money around and demanding a certain minimum to get some of that money.
(Score: 5, Informative) by legont on Saturday August 03 2019, @02:27AM (27 children)
Usually cash price is higher than what insurance negotiated.
Regardless, it is ridiculous. Just last week my wife had x-ray in a certain eastern European country and it was 200 times less than I paid using a rather good insurance. Yes, walk in price was 200 times less than insured one in the US.
Even $521 quoted here still would be 10-20 times too expensive.
"Wealth is the relentless enemy of understanding" - John Kenneth Galbraith.
(Score: 3, Funny) by krishnoid on Saturday August 03 2019, @02:37AM (1 child)
They tend to use a lot more consonants there, so basic supply and demand probably pushed the price of x-rays down a lot.
(Score: 3, Touché) by c0lo on Saturday August 03 2019, @03:03AM
Well, fuck! If that's the reason, then you, the Americans, should stop using so many dissonants then.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 4, Interesting) by Spamalope on Saturday August 03 2019, @02:42AM (8 children)
My fav in cancer treatments - they run your credit to see what assets you have - can't know what the prices is until they know what your life savings is...
(Score: 2) by krishnoid on Saturday August 03 2019, @02:45AM (2 children)
Which reminds me for all you old people -- get your colonoscopy done. A lot of times you can opt-out of the "amnes"-thesia and it's quicker.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:12AM (1 child)
TBH, I wonder what the point of the amnesia medication is. I had an endoscopy a number of years ago with nothing of any sort other than a mild numbing agent applied to the tongue and it was perfectly fine. Is it really that much worse having a similarly sized set up stuck in the other end?
Mind you, they ran that endoscope all the way through the stomach to the duodenum. And took a couple biopsies on the way. It wasn't like they just stopped in the throat or even stomach.
(Score: 1, Interesting) by Anonymous Coward on Sunday August 04 2019, @05:24AM
The reason for the sedation is four-fold. First is that with the prep, they don't want the actual experience to be bad because that just breeds noncompliance. Therefore they like to give something to wipe your memory of the actual procedure, which also can affect your memory of how bad the actual prep was. Second is that, unlike an endoscopy that takes less than 15 minutes, colonoscopies can take up to an hour per procedure (not counting recovery time), and asking someone to remain still and comfortable that long can be difficult. Third is that the intubation isn't well tolerated in about 20% of patients, even under twilight sedation, so that just breeds the idea of just deep sedating everyone because you don't know which category each patient falls into in advance. Fourth is that the actual results can be affected by the sedation level of the patient due to their mental state affecting the intestinal motility, shape, and other factors.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @06:24AM
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @09:16AM (3 children)
Is this legal?
US only, I assume.
Running a credit check in Australia would show up on the record.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @10:41AM (1 child)
Yes, it's legal (health care in the US is a for-profit industry, and treating the customers/patients is a secondary concern to maximizing profits). The credit check will show up on credit reports, but the customer/patient has to approve the credit check or they simply won't be seen by a doctor (let alone receive treatment).
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:28AM
The thing about the people who complain about this type of "progressive" pricing is they also demand progressive taxation. You can't have it both ways.
USA is the most progressive country on the fucking planet, and all businesses operate that way. Sure you think the guy paying 10k is getting the same kind of treatment as the guy paying 100k? No he is not, it's the difference between a new car with no options and the one that costs 3x as much. The business will operate to ensure as many people as can own cars, hell two if possible, but the way they go about delivering cars to people is quite different depending on what they can afford. Now some people will claim"oh you shouldn't do that! everyone should have same level of care regardless of wealth!" Well that is a nice ideal, but it is not how the world works, and it will never work that way. Even in countries where everyone is "equal" by being equally poor, the elites still get better treatment by going outside the country.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:14AM
In Australia there would be no point in running a credit check as they send the bill to the same place regardless of patient. The only real concern is that the medical records are kept up to date and the appropriate procedures are billed to the correct insurer. At no point would they be looking at a patient leaving them tens of thousands of dollars out of hospital pocket.
(Score: 5, Informative) by AthanasiusKircher on Saturday August 03 2019, @03:06AM (4 children)
I used to think that, but there are increasingly a lot of situations where that is absolutely not true. About a decade ago, I was diagnosed with high blood pressure. (All four of my grandparents and both of my parents take high blood pressure medication, so it seemed pretty inevitable that I would have to deal with this at some point.) For the first four years or so, I got my medication directly from a pharmacy located right next to my health-care provider who worked easily with my insurance and who was recommended by my doctor. I paid $10/month "copay," I think. Eventually it went up to $12/month, and then maybe even $15/month.
Then I moved to another state. I had to find another pharmacy. I was nervous about the cost of medication, as I had switched to a high deductible plan where I had to pay a few thousand dollars out of pocket each year before I'd get payments toward most drugs. So I went to a local pharmacy with some "pharmacy discount card" I found online, hoping to beg for mercy. Turns out if I got this store's grocery discount card, I could now get my drug for $12 for a 90-day supply (or $5 for a 30-day), less than 1/3 of what I was paying WITH INSURANCE before. And no, I wasn't getting some brand-name drug before. They were both generic.
Sure enough, when I looked at the grocery receipt, it listed the retail price as something like $130 for my 90-day supply, but it was "discounted" when I paid cash with no insurance to $15. I'm sure this store and others charged a lot of random people lots of money because insurance didn't get as good of a deal.
Since then, of course, I've realized these common "generic drug" discounts exist at a lot of retailers and pharmacies. I always ask about them, and since then I've switched pharmacies three times, at two of which I paid $0 for my medication. I don't live near a chain that does that anymore, but at my current pharmacy, my drug is on a list that I can get a 90-day supply for about 50 cents more (with no insurance) than if I filed with insurance, but my insurance will only give me 30-day supplies. So, to me it's worth it to pay $2/year to not have to go to the pharmacy every month. That's how little insurance gets me.
And this is not the only place I've heard of this happening in medicine. If you think about it, actual CASH prices (not prices for billed costs to customers, but actual payment on the spot in cash or something equivalent) SHOULD be cheaper, as it cuts out huge amounts of costs for the middleman, time for filing and arguing with insurance companies that providers do, etc. The only reason costs are more expensive for individuals who are billed is because of a high delinquency rate on medical payments. If you walk in and offer to pay for your ultrasounds in cash, if the provider was acting rationally, they should definitely give you a better deal than what they would be billing your insurer for. Just like walking into a used car dealership with cash in hand. You can usually get a much deeper discount by avoiding all the details of payment, checking credit, setting up loans, etc.
Of course, we do not live in anything resembling a rational system when it comes to health care billing in the U.S., so most cash customers do pay more. And it's often next-to-impossible to find out what the exact cost of your procedure may be in advance, even for basic stuff. The insurance stuff completely mucks up everything. The easiest way to make health care costs drop overnight would be to require all costs for procedures costing less than a few thousand dollars (or whatever) to be posted clearly, perhaps along with a reasonable "cushion" in the case of emergency complications for more complex things.
If I can go to an auto mechanic and get an "estimate" before they do anything to my car, I should be able to get the same thing from a doctor or a hospital. It's the only honest way to do business. The only difference, as I already mentioned, is the potential for emergency complications in the case of more complex procedures, where they may not be able to get your consent in the middle for an increase in cost (unlike a mechanic who encounters a complication). In the case of everything but major procedures like major surgeries, they should be able to provide a list of potential complications, the relative risk of such complications happening, and an estimated cost for dealing with them in the midst of a procedure.
Short of going to single payer (the only rational choice in a civilized society, in my opinion, but I accept there are those who disagree), that's about the only efficient way to fix our system quickly. If providers offer discounts for someone with insurance, it should be very clear and straightforward and listed on the estimate -- and ALL such deals should be open and public and listed for all types of insurance, so everyone sees what discounts can be had and from whom.
The fundamental problem is a sequence of middlemen that have no interest in serving the consumer, coupled with complete lack of transparency. The only way to combat that is to shed a light directly on the costs.
(Score: 2) by SemperOSS on Saturday August 03 2019, @08:47AM
I think the in-procedure crises could be handled by adding a small surcharge to the price of the procedure (an "insurance" of sorts). The surcharge would be calculated by averaging the known risks of the procedure meaning that the many that do not experience any crisis would pay for the few that do ... except the hospitals would like to insure the insurance too and add many times the actual risk cost instead of just enough — just in case. Also, many people would probably consider this "socialist treason" and anti-libertarian dogma.
Sigh!
I don't need a signature to draw attention to myself.
Maybe I should add a sarcasm warning now and again?
(Score: 5, Interesting) by DavePolaschek on Saturday August 03 2019, @11:16AM
I was self-insured from 1998-2006. Cash price was always cheaper than insurance at the doctors I went to. I didn’t do a lot of shopping around, and frequently went to the then-new urgent care facilities. But I also went to the People’s Clinic [peoples-center.org] for routine stuff, as payment was based on your (self-reported) income, and the care was always good. They always seemed surprised to see a non-indigent nerd showing up, and they told me that I was paying more than I had to by reporting my actual income, but it was affordable enough.
I had more than one talk with the billing person and she said that one of the things that kept their costs low was that they didn’t do insurance paperwork unless absolutely necessary. They just got what they could from the patient and used med-students from the nearby university and doctors donating time to keep costs down. I think that’s changed somewhere along the way, but they’re still in business, so they’re doing something right.
(Score: 3, Informative) by bobthecimmerian on Saturday August 03 2019, @01:42PM
Sure. In 2007 through a paperwork screwup my family was uninsured and my wife needed an emergency MRI. We were billed $7,000 and I negotiated the payment down to $4,300. I paid it with a credit card. A few months later I called the same hospital and asked to get an MRI, and asked what the price was if I paid cash up front. Answer: $250.
Three years ago I had a family member in the hospital from December 30 to January 10. During that time my health insurance switched on January 1 from one insurer to another. The hospital accepted payment from both insurers. But when the billing was processed, the two insurers played football with the bill, arguing with each other and the hospital over who was responsible for what. The hospital billing department appealed their decisions a few times but missed one of the deadlines to appeal and extend the billing consideration period. Because of that, all future billing requests were denied because they hadn't been processed within 180 days of discharge plus the extensions to the billing period added by previous appeals. Now, according to the papers I signed during the admission process, if my insurers screw up I am responsible for the balance. So the hospital could have sent me an $18,000 bill. But to their credit, they told me they wouldn't punish me because the insurers figured out how to screw them. They got nothing.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:36AM
That's not surprising, the first blood pressure medications that they generally prescribe are diuretics that have been around for ages. There are other medications that are more expensive, but usually they won't go to those until after the cheaper ones.
And yeah, those are often times less expensive if you don't involve insurance. It seems like I was paying like $6 or so a month for my supply back when I was taking it.
(Score: 2) by JoeMerchant on Saturday August 03 2019, @03:32AM
That's not even a very big spread, I've seen 10x and more difference on items, and then there's the amount the insurance "allows" which could be $80 in a case like this.
🌻🌻 [google.com]
(Score: 5, Informative) by driverless on Saturday August 03 2019, @03:40AM (1 child)
Holy fsck! The price for an ultrasound here is around USD70 walk-in, and this is a generic first-world country where things aren't that cheap in general. An X-ray costs about the same, and the tech was apologetic to me about how high the cost was. Just to clarify that, that's not government-subsidised, that's what the medlabs charge you. So compared to $1,739 for two that's under one-tenth the price of the US.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @04:46AM
butbut muh R&D
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @06:19AM
(Score: 1, Interesting) by Anonymous Coward on Saturday August 03 2019, @10:36AM (1 child)
Not in my experience. I recently had an MRI done on my knee (pro tip: don't rupture tendons or tear your meniscus). Insurance price was $2,550, self pay was $475 (if paid up front). I told them I didn't have insurance because I'm well below my $5k deductible.
The administrative costs for dealing with insurance companies are ridiculous and the medical practices pass that cost (plus markup) on to the patients. Plus, the time it takes to get payments from insurance companies slowly increases. It is not unusual for Medicare payments to take 12-14 months. Floating that much accounts receivable is hard when staff, leasing companies, insurance carriers, etc expect to get paid on a timely basis.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:23PM
No, the charge cost was $2,550. Your self pay was $475. The price insurance would have paid would have been about $350 and the proivder would have been ordered to write off the other $2,100.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @12:27PM (1 child)
No usually it is cheaper, the only people who think cash price is higher are those who tell them they have insurance before asking. Once they know you have insurance they need to tell you the cash price in their contract, not the real price.
Admitting you have insurance is like writing sucker on your forehead. The only other people who have it are using it as a tax avoidance scheme.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:25PM
If the insurance company finds out the provider is discounting a self-pay less than the insurance (and they will sooner or later), then that provider is told that they either keep their self-pay prices about the insurance price or they kiss their contract goodbye. The whole point of the insurance contract is that the insurer delivers volume in exchange for getting a discount less than what the ordinary person pays. That does not have to be the chargemaster rate of the procedure, just higher than what the insurance rate is.
(Score: 3, Funny) by Runaway1956 on Saturday August 03 2019, @02:15PM (2 children)
Eastern Europe? That wasn't exactly an X-ray, was it? They have an old Soviet nuclear warhead hidden behind the curtains. You walk in front of it, and the radiologist reads you, live.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @03:36PM (1 child)
you should learn how nuclear weapons work before making stupid comments that attempt to be funny
(Score: 2) by Runaway1956 on Saturday August 03 2019, @03:54PM
And, you should pull that three foot long stick out of your ass before you presume that I don't know how nukes work. I worked, slept, showered, shit and shaved within the confines of a floating nuke silo for 2 1/2 years. My shipmates and I joked about this shit all the time, thank you very much.
(Score: 3, Funny) by krishnoid on Saturday August 03 2019, @02:28AM (4 children)
It's a problem with the billing and financing of healthcare. I can't imagine the hospitals and doctors offices love tracking different information for every single (insurer, patient, procedure) when they'd rather, you know, provide the actual healthcare. They would have become accountants if they wanted to spend their time tracking all that.
I think the (Amazon, Berkshire, Chase) partnership is trying to help with this, but who knows.
Uh, sure ... if you want them to put you on a table, cut you open, and close you back up before giving you a written estimate, you could probably find someone in an alley to do that for you. Or just have them install an OBD-II! I bet that would save a lot of time and effort up front.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @10:59AM
Is that the device that reads your insurance card to determine how sick you are & what treatments you'll receive based on your coverage?
In all seriousness, my insurance doesn't cover installation of the ODB-II and the copay for reading it almost like not having insurance at all.
(Score: 1, Informative) by Anonymous Coward on Saturday August 03 2019, @07:17PM (1 child)
Most procedures are fixed cost beforehand. There is a LARGE set of documented procedures on it. They are all pre-priced pre-coded. Walk in X dollars. Cotton swab y dollars. Check for persistent cough z dollars. Test for a b and c, Q dollars. So on and so on. They have at least a ball park of what something costs. It is in their computers. Source: I designed systems like it in a past job.
They *know* what the 'real cost' is and what each insurance companies negotiated cost is. They already know. Surprises sometimes happen when you open someone up even that is fairly rare because of tests beforehand. Non surprises are here to get the shot so you do not get the mumps. That is fixed and up front. Not all things are an emergency. Even many surgeries are that way. I hear from friends and co-workers all the time 'I am going in next week to get ABC taken care of'. The costs are already pretty nailed down. There is not going to be much 'gotcha' there. You have an ulcer. It will be known within a small margin of error what the cost will be up front. Just like a car mechanic. You can call one up and say "i want to switch out the alternator on my 2003 Chevy Malibu what is the hours and cost on that'. They will say 'about XYZ' depending if there is something else. Mechanics have the added benefit they can stop in the middle of a procedure while you may not have that option in an operation. But lets say I break my arm I go into the doctor. He fixes and sets the arm. Puts the cast on it prescribes some pills for the pain. He MAY notice hey there is a spot on my arm that may be cancer you may want to check that out. He is not going to stop and start chemo right then and there. Same thing with a mechanic. They do the procedure and see something else...
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:16PM
Uh, no. You don't know how billing for healthcare works, no matter how similar you think it is to your prior work, sorry. My source: I work in the industry, directly.
Where you are right: There is a set list of procedures, copyrighted by the American Medical Association, which is called Current Procedural Terminology (CPT). It runs from code 1000[2]? through code 99999 (unspecified and unknown procedure). It is not 89999 numbers because there are blank files. CPT is broken down into 5 primary areas: Surgical (or other invasive) procedure (codes 10000-69999). Radiology (diagnostic and interventional, 70000-79999). Lab diagnostics (80000-89999) "Nonsurgical management" (we don't have to cut you, but it's not a straight up office visit, 90000-95000), and Evaluation and Management (office visits, hospital consults, etc., 96000-99999 but really just 99xxx.) There are thousands and thousands of codes. Your physician knows a bunch of common ones. Your physician does not know them all. Guaranteed. Not even coders stay current with everything. But there are books to look stuff up.
Where you begin to be wrong: You have an ulcer. What kind? Gastric? Esophageal? Duodenal? OH, you don't know the type! Silly person. So, you're going to come in and the physician will look you over. The physician confirms you have a gastritis, but you have no vital sign issues or other pathology that indicates that this is a crisis or needs any kind of aggressive management. The physician *doesn't care* which type you might have so long as he can be reasonably sure you're not going to bleed out or develop an immediate complication which might put you in jeopardy. (Actually, esophageal ulcers might well get some additional treatment then and there because esophageal bleeds are generally medical emergencies) - HEY, you just got sent to the Emergency Room! But here's what he will tell you to do: Go home. Get rest. Take some OTC meds. And if it is still bothering you in two weeks come back in and they'll go to the next step.
Now, should the physician's advice here be free to you? Oh. How much is fair for his opinion that a) you aren't dying, b) most people recover from gastritis without further complications with care available at home, c) first time ulcer symptoms may well resolve themselves although process on this is changing, d) if it is actually an ulcer then here's what to look out for and do next.
But wait! You have been going for six weeks this way before you walked in the door, and you have tenderness that may indicate this isn't an ulcer but a herniation.... all righty then. The physician feels around, and thinks you *might* have a herniation, but he can't tell for sure. Off you go for your X-Ray! Now, is that going to be 2 views, or 3 views, or is he worried about bleeding so he wants a CT instead? (Or, you're sweating too and your heart is beating fast and your BP is skyrocketing. Nope! Not ulcer! Chronic angina that may have already progressed to heart attack!)
Fast forward, and a surgeon is going to cut into you to repair your hernia. Is the surgeon going to use the posterior approach, anterior approach, laparoscopic? Is he cutting the upper stomach or the lower stomach? Now, I'll admit I haven't looking into all the possible herniation and ulcer codes. Not my field. I've got the book for it. But I can tell you that a single procedure may have any one of 10 codes, each with their own costs, for the basics of the procedure. ANY of those codes are modifiable by what are appropriately called "modifiers" for things like 'we only did one side,' or, 'we needed a second physician here,' or, 'we had to stop the procedure [because the patient was going south fast]'. NO insurer publishes a full list of how they slice and dice modifiers.
The physician might only have a clue about how long your procedure will take. Maybe they start with one approach and have to back out and try a different one (oh, but that different approach didn't get precerted! sorry!!!)
All this is a way of saying no, your physician's office has no real clue of what taking care of your ulcer may ultimately cost. And any physician stupid enough to quote you a price is likely one you don't want to go to. Could there be a basic idea of what it *might* run if there are no complications? Yep - they might have clues about what each level of care ballparks at. But the second a provider says, "well, uncomplicated it will be $XXXXX" then the patient WILL scream bloody murder if it is $1 over that even if the patient didn't follow physician instructions and introduced a riverload of complications by their own fault. And then you get another article about how physicians don't live up to their "billing promises."
Sorry about the length. The next thing that happens is your physician dictates (or otherwise records) the exact procedure done and all steps in it. Then a professional coder reviews that dictation, consults those books and comes up with all the charges that are applicable. (No, each cotton ball is not accounted to you by the physician. Hospital biling, different animal entirely, BTW. Those are managed by Diagnosis Related Groups, where your ICD-10 medical diagnoses specify how much the hospital will get even though they account for things like surgical and wound management trays and each pill you get.)
Anyway, the coder submits it to your insurance. The insurer (let's say Mingmong Insurance) runs those CPTs, crafted exactly for what you went through, through their systems and they find out that you have a contract with Gorpdork insurance to pay 10% less than what Mingmong would pay. And Mingmong and Gorpdork have a contract! So NO, the provider gets paid what they would have been if you had Gorpdork instead! Yay!
My basic point is still, no, healthcare is much more complex as I said earlier. Your mechanic knows every single step that replacing that alternator will take and there is only one way to do the job. That isn't healthcare, and be glad it isn't.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @05:30AM
there's also a huge database the mechanics use to make those estimates. they do not make them up on the fly.
perhaps it would be nice to go to the ER, needing stitches. the procedure will involve some lidocaine. some time and labor to flush the wound. and actually getting the stitches. ok, I get the ER has a shit-ton of overhead they need to bill for too.
both my after hour suture procedures billed out at over $2000 each... there is still a degree of WTF for me there...
I'm just glad as a kid I didn't break an arm or leg, inadvertently draining the nascent college savings my parents might have started...
(Score: 5, Insightful) by Arik on Saturday August 03 2019, @02:32AM (9 children)
Which makes it that much harder to save the cash needed.
Mandatory insurance only benefits the insurance companies, and their pet politicians.
If laughter is the best medicine, who are the best doctors?
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @09:25AM (4 children)
Just wait until you have an actual medical issue to pay for. Being hit for thousands for something you thought you were covered for really sucks.
I did a calculation for the 'insurance' I have. I would need to have several very nasty problems happen in one year to break even. Break even mind you.
Completely and utterly useless.
(Score: 1, Informative) by Anonymous Coward on Saturday August 03 2019, @12:59PM (3 children)
My friend is diabetic and found out his new insurance (he became a federal employee) won't even cover insulin. Totally worthless mandatory waste of money.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @07:57AM (2 children)
https://www.washingtonpost.com/news/magazine/wp/2019/01/07/feature/insulin-is-a-lifesaving-drug-but-it-has-become-intolerably-expensive-and-the-consequences-can-be-tragic/?noredirect=on [washingtonpost.com]
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @04:07PM
What's this bullshit about "keeping the same doctor"? Apparently you can't afford him, so move in. How much would have Obamacare cost for basic care and prescription coverage?
(Score: 0) by Anonymous Coward on Monday August 05 2019, @01:07PM
tl;dr The system is broken
(Score: -1, Troll) by Anonymous Coward on Saturday August 03 2019, @11:07AM
Just splurge and self-pay for the lobotomy we all know you desperately need. Oh, and be sure to tell us you got it because we may not be able to tell based on just the content of your posts.
(Score: 2) by hendrikboom on Saturday August 03 2019, @12:27PM (1 child)
In the culture of corruption which seems to prevail in the United States, yes.
(Score: 0) by Anonymous Coward on Tuesday August 06 2019, @10:43AM
FTFY
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:41AM
The problem isn't the mandatory insurance, the problem is that the GOP has continually fought for policies that cover nothing so that you can pay a low premium. Then you get something serious and go bankrupt because the policy didn't cover anything.
Requiring everybody to have insurance would have worked had the GOP not sabotaged the bill. A large part of what drives up the cost of insurance was charity care and people not receiving preventative care. It would have taken ages for the cost of insurance to come down to the point where insurance was reasonable again as there's many millions of people who hadn't been receiving routine care or treatment for preventable illnesses. But, it would have eventually come down a lot.
Still not really good enough, we should have had a public option at a minimum and medicare for all as the only option.
(Score: 5, Informative) by Anonymous Coward on Saturday August 03 2019, @02:38AM (15 children)
I've had 4 kids (and a subsequent vasectomy) sans insurance in the southeast US. The totals I ended up paying for the kids were 7000, 1300, 1400, and 1700 to the hospital. The doctor was 3000 for each, which included prenatal and labs. I paid 700 for the vasectomy.
The hospital bills range from batshit crazy, to bad but not untenable, mostly due to a series of corporate takeovers of the hospital over the intervening years. The doctors bill wasn't great, but it included a crap load of visits, ultrasounds, delivery, tests, etc. The upfront numbers on all of the baby related stuff were initially 2 to 4 times what I ended up paying. Getting the billing people to understand that I would be paying out of pocket was truly challenging. The hospital billing department in particular, had one of the highest levels of malevolent incompetence I've ever seen. They tried to dodge the itemized bill, with which you can dispute individual bs items, like $20 ibuprofen you never received, by lumping everything into a single "birth package" line item. I was too young and naive to get the 7k bill for the first into a reasonable range. I did a little better with the others.
The vasectomy was originally quoted at 3500 for the doctors part. Same day surgery costs at the attached hospital would be billed separately at a cost no one could name. Once the billing department figured out I was paying cash, the doctors quote dropped to 1500, and they could suddenly do it in the office with no trouble. I paid cash up front, and two weeks later got a check in the mail for just under 800 because they still managed to over bill on the cash price. I'm not sure why they refunded me, cause based on what I'd seen, 1500 was still pretty good.
I think health insurance is the major cause of the fucked uppedness of the US healthcare system. Have you seen the requirements of medical billing and coding? It makes the tax code look friendly. They take something that should be relatively upfront and hide it behind 3 contractors and 7 extra layers of bureaucracy. Now we have required health insurance, which certainly isn't helping anything, especially if you don't have a corporate job with decent benefits. Heaven forbid you be self employed.
The best part about the births was the random lab bills that would trickle in after the main event. Shit that I'd never heard of that was supposedly ordered while we were in the hospital for all of 30 hours each time. LabCorp and Quest Diagnostics got told exactly where they could put their bills if they couldn't tell us exactly who ordered the tests and what happened with the results.
My solution to health care in the US, at least for the short term, wouldn't be single payer or mandated insurance, it would be mandated reasonable maximum pricing based on something like the medicare book-o-prices. Of course, that would probably eliminate a shitload of jobs, since large chunks of the US labor force seem to be healthcare related in distinctly non-treatment ways. It would probably also eliminate a fair number of insurance plans, as individuals and families would have some small hope of actually being able to plan for covering medical expenses.
(Score: 4, Interesting) by MostCynical on Saturday August 03 2019, @03:43AM (3 children)
Compare the Socialist Utopia, Australia [thebillfold.com]
"I guess once you start doubting, there's no end to it." -Batou, Ghost in the Shell: Stand Alone Complex
(Score: 2) by driverless on Saturday August 03 2019, @03:47AM (2 children)
Yeah but that's Australian dollars which is like what, a buck fifty and a kangaroo-leather belt in the US?
(Score: 2) by MostCynical on Saturday August 03 2019, @03:55AM (1 child)
Right now, 1 Australian Dollar = 0.68 United States Dollar
Bit more than the peso, but not much..
"I guess once you start doubting, there's no end to it." -Batou, Ghost in the Shell: Stand Alone Complex
(Score: -1, Offtopic) by Anonymous Coward on Saturday August 03 2019, @07:32AM
But the Pound will soon undercut the Auzzie Dollar, and the Euro, and all other currencies, as the "No-deal Brexit" Brexits across the world. Poor Australia, and The Part of Ireland that is not Part of Ireland! You bastards should have thought better in 1914! Or so. Bloody Brits! Fricken Poms! Damn Redcoats!
(Score: 4, Funny) by driverless on Saturday August 03 2019, @03:45AM
Well if you've had both 4 kids and a vasectomy I can see why your healthcare costs would be unusual, that kind of anatomy isn't really everyday. Mind you you could sell your body to science and recover it all later.
(Score: 4, Interesting) by AthanasiusKircher on Saturday August 03 2019, @04:25AM (8 children)
Indeed. A few years back I went for a physical. My insurance covered a free physical with basic lab tests, etc. once per year as preventative care. My doctor's office filed the claim wrong, and I was billed for a couple hundred dollars. I called them up and they filed again. This time it came back with different errors. I called the insurance company and they said they filed the wrong codes -- the correct procedure code but some secondary code for the reasoning was wrong. By this time six months had passed, so I was due for another doctor's visit, at which point I explained my last billing stuff was still wrong. They filed a third time. Again, a different but still incorrect bill arrived.
I called the insurance company again, and once again my doctor's office could not figure out how to file the right codes... So I begged the insurance person to just tell me what codes they needed so I could tell the doctor, but she couldn't tell.me that -- that would apparently be like facilitating fraud by telling me how to file my own procedures to save money.
Eventually, after speaking to a manager, I convinced them to call my doctor's office directly and discuss how the codes work. Apparently they could talk to a provider about the codes, but telling them to me (even though they had to do with MY healthcare) could be seen as some sort of fraudulent influence.
All of this to file the correct codes for a routine physical.
Finally, nearly a year after the physical, my latest billing statement arrived. They actually refunded me about $11, because they had actually misfiled the insurance claim a fourth time. But in the process they had accidentally double-credited me for something else, so I ended up $11 ahead of where I was supposed to be if they filed things correctly. So I gave up and just took the $11. I guess "close enough" is the best you can hope for in medical billing. (Note also that this was not some obscure weird insurance -- at the time I was in a standard state health plan for all government employees in the state that had only two options.)
Since then, if I am going to a physician for something routine, I bring a copy of the relevant part of my insurance benefits book that covers my visit and sit down with the billing person before I leave to try to make sure they understand how to file my claims. I've had only one error since then, and not a big one.
Medical billing is insane in the U.S. I dread the day when I'll need to have aakor procedure, as I can't imagine the mess that could happen.
(Score: 2) by AthanasiusKircher on Saturday August 03 2019, @04:28AM (2 children)
I have no idea what autocorrect did to my final sentence, but I meant "a major procedure."
(Score: 1, Funny) by Anonymous Coward on Saturday August 03 2019, @01:03PM
The dreaded, yet inevitable, Aakor procedure.
(Score: 3, Funny) by Runaway1956 on Saturday August 03 2019, @02:29PM
Don't sweat it. English is evolving, after all. Kovfefe!
(Score: 4, Funny) by aristarchus on Saturday August 03 2019, @07:44AM (2 children)
This is why we cannot have nice things, like single payer health insurance!
Exactly, saving money under a capitalist insurance regime is fraud! Athanasius! Give us a pound of your flesh, closest to your heart! Or pay the out-of-network fee. Same diff.
(Score: 3, Interesting) by AthanasiusKircher on Saturday August 03 2019, @03:35PM (1 child)
Yeah, that was one of the crazier things I encountered in this process. It was a really weird reaction from the person on the phone when I just asked (innocently) for the codes. She kind of made some noises and then said, "Of course I can't do THAT..." And I said, "Why not? I just need my doctor to get this right, and clearly they can't figure it out." And the reply was, "Well... I mean, you can see that we can't be telling patients how to code their procedures! That would be fraud!"
Although the person on the phone was generally nice and helpful, I was treated as if I were suggesting criminal activity just because I recommended an efficient solution to an obviously stupid process. Also, it should be noted that the insurance person on the phone by that point could see from the history of the claim what the doctor's office was TRYING to do. The way it was coded didn't MAKE SENSE. So, it would obviously not be "fraud," since it was pretty clear from the list of stuff that I had just had a physical, not some random set of specialized tests to treat an abdomenal problem or whatever it was coded for at that point.
It's all absurd.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @01:21PM
In Australia they are required by law to provide you with the information required to find out what is required and how much it will cost. Actually getting the correct codes is a serious PITA. Then you find that they won't quote until you book an appointment or operation or they just can't do it because they don't know which health care professional will do each part and since they all charge differently I'm sorry we can't quote you.
I found a way around it. First, nail down the parts you can get a hold of. The codes for the doctor and the parts of the procedures they do know. Then research approximately what they will cost. Then book a doctor, but don't go to the appointment. Before the appointment get them to book the actual procedure in the future. Get them to provide you with an invoice. A while later cancel it. Wash rinse and repeat until you have the numbers.
Given the range of cost can be in the thousands to tens of thousands it might be worth doing. Most people won't bother. The public hospital system is so much easier. Go to a doctor, get a referral to a specialist or surgeon or whatever, go to the appointments. Go to the hospital. Deny them access to your private health insurance details. Get it done. Get on with life.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @01:27PM (1 child)
And how much were you compensated for all that time and attention you had to spend on it? Don't shrug and say it was no big deal. Imagine if you had to do that every time for every product or service you buy. I went to a store with one of those self check-outs the other day. I couldn't figure out how to weigh the bananas. The attendant helpfully tried to train me how to use their "automated" system. There were four steps involved. Funny thing. I don't want to be trained as a grocery checker. I don't want to be trained as a medical billing expert. Imagine if I expected my clients to be trained as database administrators so I could shirk responsibility and sluff-off my mistakes as "no big deal, you deal with it...
(Score: 2) by AthanasiusKircher on Saturday August 03 2019, @03:43PM
I would NEVER shrug such a thing off. I was positively incensed the entire time. I seriously considered sending the doctor's office a bill for "account research," but I thought it was too unlikely that they would pay it. So, I just quit going to that doctor, after having a conversation with the billing person and my doctor about precisely why I was leaving. Most billing people aren't quite so incompetent, but the underlying problem is of course the overcomplicated system.
One surprising thing about this was that no one at any point said, "No big deal, you deal with it..." to me. At no point did the doctor's office object to refiling the claim several times. They were always polite to me, always promptly removed late charges from my bill when I requested a refiling (even though they ultimately didn't get their money until almost a year after the visit), and honestly I think the first incorrect filing started because they didn't look at my insurance in detail first and tried to code things in a way to SAVE me money. And the insurance people were polite and nice most of the time too.
It didn't make me any less angry about the whole thing, but actually -- with the exception of when I was refused billing codes -- everyone I interacted with was actually TRYING to help me resolve the issue. The problem was that the system was so insane that they couldn't communicate correctly to get it to work the right way.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @03:26PM
Basically all that billing and coding is required by Medicare/Medicaid regulations. They're also why it's so damn hard to get a price upfront. If you look around, you can find physicians that refuse Medicare/Medicaid patients and are willing to operate on a cash basis, and the billing is so much easier to deal with (and reasonable, as well).
(Score: 4, Informative) by ElizabethGreene on Saturday August 03 2019, @02:49AM (1 child)
I have a EOB for a Lab test that was $1200 before the insurance company discount and under $20 after the discount.
This is the fundamental flaw driving cost of care in American healthcare.
Doctors start with the price they need to charge to make a small profit, and then multiply that number by a double or triple digit percentage so they have enough room to offset the insurance discount.
It needs to change.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:29PM
No, that's not quite the way it works. I wrote a long assed post above showing a bit of how we got here.
What you're not being grateful for is not having to pay a "reasonable" amount.... Would you have been happier if the EOB said, "$100. Insurance Discount: $20. Pay up $80, sucker!"?
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @02:57AM (6 children)
Cost me $60 once a year for 5 years to screen for marijuana. Doc changed the lab they use for the piss test... $1250.00. Doc said call them and complain, they gave me a 90% discount. Then the price of fentanyl patches jumped from $95 to $1500 per month. The entire USA medical system is bullshit. I weened off the fentanyl and started using marijuana which I can get for $90 which lasts 3 months and works better.
(Score: 2, Interesting) by Anonymous Coward on Saturday August 03 2019, @05:15AM (4 children)
marijuana helped me escape alcoholism when nothing else could
10 step programs have a terrible rate of success, yet the puritans in charge insist on it, because they know it will keep us addicted to things that are harming us but are vastly more profitable
(Score: 0, Touché) by Anonymous Coward on Saturday August 03 2019, @07:48AM (3 children)
Alcohol helped me escape a nasty marijuana addiction, when nothing else could! I went from being a socially rejected stoner polyamorist trans-gendered Bernie supporter, to just a normal drunk. So much easier. But the liver transplant is gonna cost me. And, Ten Step? Do you not mean Twelve Step? Or are you still stoned?
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @11:09AM
Dude, you're holding it wrong.
(Score: 2) by Runaway1956 on Saturday August 03 2019, @02:34PM
Ten step, twelve step, just move to Texas, and it's all two-steppin'!
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @04:14PM
Nothing's perfect. But Bernie supporter! Them's fighting words!
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @12:28PM
This is one of the reasons big pharma are so against marijuana. They don't want a cheap product undercutting their expensive products.
(Score: 2) by krishnoid on Saturday August 03 2019, @03:05AM (3 children)
Because you didn't call ahead and ask? Maybe, at least what the price range is for this procedure has been in the past? Or, you know, ask your Google home first? It would give you *some* idea.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @11:12AM (1 child)
Not necessarily. Prices vary widely based on provider, facility, city/state/region, etc. I've even encountered a significant price difference between doctors in the same medical practice.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @12:43PM
I need to have a procedure done, and soon. I can ballpark what it may cost to start but if it gets interesting then there is no way to tell. They will tell me what the doctor may charge and what the fees may be to start but the final bill won't be known until they been a knock out doc and work out some other details. In other words you won't know the base cost until the day. It sucks. You won't know the full cost until after. They charge for every additional step in the procedure. Heaven help anyone out there who is really sick.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @05:40AM
doesn't help much when you are there because of an urgent or emergent problem, especially if it is not during normal business hours. or an unexpected problem is discovered...
(Score: 2, Insightful) by fustakrakich on Saturday August 03 2019, @03:28AM
Is there something abnormal here that I missed?
La politica e i criminali sono la stessa cosa..
(Score: 2) by The Mighty Buzzard on Saturday August 03 2019, @04:12AM (18 children)
Your provider saves themselves a ton of paperwork and record keeping if you pay cash. Easily ninety percent of their paperwork is insurance or medicare/medicaid mandated. Since they have to pay very highly trained and paid people (starting with your doctor or PA and every nurse you deal with but including several more before the bill gets paid) to deal with that paperwork, it adds a hell of a lot to the price of any treatment.
My rights don't end where your fear begins.
(Score: 3, Interesting) by krishnoid on Saturday August 03 2019, @04:46AM (17 children)
Yeah, but for them all that upfront cost has already been paid. Your visit would be a single bill in the stream that goes to the multiple insurers, which I doubt would be be a big deal. However, it would mean they're guaranteed there's no back and forth to get paid; they can *negotiate* -- ask to negotiate the price -- an actual price directly with you for immediate payment, and they'll probably cut a deal rather than insert you into the *non*-insurance payment plan/billing paperwork stream.
Still, I'd really like to know -- how do hospital management, administrative staff, and medical staff actually feel about socialized billing vs individual billing? Which of them would prefer it one way or the other, which of them are removed from the process enough that they don't care, and which informed ones don't care?
(Score: 2) by The Mighty Buzzard on Saturday August 03 2019, @05:16AM (16 children)
I don't personally know a single medical professional that's not adamantly against socialized medicine. Ditto Obamacare.
For "them" who? It sure as shit isn't already paid for our current healthcare providers. They have to keep a larger staff on hand because all the doctors and nurses spend at least half their time doing paperwork instead of treating people. Pay cash and they spend a tenth that time with your paperwork and get on to the next patient. Better for them, better for their patients.
Now before you say taking insurance out of the mix and socializing things would reduce paperwork too, I invite you to take a gander at the wonderful world of Medicare billing requirements. Government bureaucracies produce more paperwork and less actual work than any other system.
My rights don't end where your fear begins.
(Score: 2, Informative) by Anonymous Coward on Saturday August 03 2019, @05:44AM (6 children)
Ah yes, anecdotal bullshit.
The assumption that systems can not be fixed is ridiculoys. The real problem is the health insurance. Insurance operatives are bean counters by role, the very definition of pain in the ass burearacracy.
For profit is the major problem. Some sectors of human society should not be profit motivated, and should extend service to all. Humanity can support this, thus it is a moral imperstive.
Wait there's more, the literal examples abound of successful social healthcare systems. Everything else is FUD in the worst way, where the death panels are everyday insurance auditors, undoubtedly with their employment tied to performance metrics and unwavering "guide lines." And here is our resident bird brain shrilly bleating their cheers.
(Score: 2) by The Mighty Buzzard on Saturday August 03 2019, @12:56PM (5 children)
He asked for anecdotal, dumbass.
No, dumbass, it can't support this. Available care and advancements at the pace the US has set cannot be maintained without paying a whopping fuckload more than the US government takes in in taxes every year. Oh, sure, if your little nation is willing to be a parasite and sponge off US innovation you'll be able to get by for a while with slow, mediocre care. If we do it the science of medicine slows to a trickle and you're all fucked though.
My rights don't end where your fear begins.
(Score: 0, Informative) by Anonymous Coward on Saturday August 03 2019, @01:10PM (1 child)
I'm pretty sure the Chinese disagree with you and will eat the USA's lunch within 5-10 years.
Being able to buy the same meds from Canada for much much cheaper than they can be purchased in the US clearly demonstrates that the US consumer is getting screwed. The existence of "medical destination" countries also prove this fact.
Your "We are the US and fuck you for not being the US" attitude leads to you paying a lot more, and getting a lot less, than the rest of the civilized world. Complacency leads to downfall. Just ask ... oh, wait, you can't because they are already extinct.
(Score: 3, Funny) by The Mighty Buzzard on Saturday August 03 2019, @02:11PM
No, it doesn't. And your ability to reason is clearly suspect if you believe it does. Now we are getting screwed but you are wrong in your proof of how and don't comprehend the why.
It's not an attitude. We objectively, empirically are the shit when it comes to advancing medicine. Deal with it or start pulling your weight.
My rights don't end where your fear begins.
(Score: 2) by AthanasiusKircher on Saturday August 03 2019, @03:57PM
Oh, woe is Big Pharma! They will certainly DIE if we had a reasonable payment system for most people.**
No, they wouldn't. Be rational. You don't outlaw private insurance. This is where we make the huge amount of inequality in the U.S. work for everyone! It's all simple -- rich people will continue to pay ridiculous sums just to live a little longer. Let them. They can subsidize Big Pharma and "innovation." Capitalism at work.
Meanwhile, give everyone at least an OPTION for reasonable healthcare. Maybe it's 5 years behind what the rich get (or whatever is worked out), so you can't get the latest experimental treatment that will cost you a million dollars a year. But Big Pharma gets its stupid profits to "innovate" (as well as pay its CEOs, which is where a huge amount of this is going too), the average American gets healthcare, and money is siphoned out of the rich to decrease inequality maybe just a little in the name of improving society overall. Win-win for everyone!
Oh, but wait -- you object that the rich should pay more? Nope, that's capitalism for you. The idea of a "fixed price" is a socialist construct come up by Quakers and other liberals, forced on the population in the late 19th century. Before that, most goods had to be negotiated for, and if a seller sensed you had more money to pay, chances are you'd be offered a higher price. We return to the roots of capitalism to save "innovation" -- isn't that what you want?!
---
**Not to mention that the current state of medicine is high enough that the average lifespan has been extended well beyond what many people could expect a few generations ago. I'd be happy if I continued to have access to the current level of medical care for the remainder of my life, if it were offered at reasonable cost.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @04:07PM
Sounds like US is a 3rd world country. And the "advancements" are not made by the last-mile of the healthcare system but mostly by the publicly funded researchers. And "available care" is not available, unless you can pay. Like in 3rd world country.
https://upload.wikimedia.org/wikipedia/commons/0/0a/Health_care_cost_rise.svg [wikimedia.org]
You are doing something really fucked up when you start at same place and are the only outlier. And not only that, on this group you are the ONLY country without a universal healthcare system.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @04:35PM
Ah, there's muh R&D.
(Score: 3, Informative) by hendrikboom on Saturday August 03 2019, @12:46PM (6 children)
I do. But I live in Quebec in Canada. Many of the doctors that move from here to the U.S for the "big bucks" return to Quebec so that they can actually practice medicine instead of dealing with insurance companies and lawyers.
-- hendrik
(Score: 3, Informative) by The Mighty Buzzard on Saturday August 03 2019, @01:02PM (5 children)
Several of the medical professionals I know just flat quit practicing when Obamacare went through. More bullshit, less helping people. The insurance industry we have today is by no means a good thing but then neither is our government. Neither is currently capable of being the answer to this question.
My rights don't end where your fear begins.
(Score: 1, Informative) by Anonymous Coward on Saturday August 03 2019, @02:09PM (3 children)
And no one said Obamacare was what they want. Medicare for all is the least that should be done, but since it will be universal then the bureaucratic red tape should disappear.
I say should because those greedy insurance fucks will undoubtedly grease some wheels to keep the pork rolling in. Don't like wasted time and money? Bitch at the corrupt assholes.
(Score: 2) by The Mighty Buzzard on Saturday August 03 2019, @02:15PM (2 children)
You're fucking hilarious. Even the other Dems running this time around know "medicare for all" will cost way, way, way too fucking much for us to pay. Estimates from the fucking Dems say it's going to cost like 75% of what we take in in taxes every year all by itself. The only ones fucking retarded enough to believe that shit are you and Kamala Harris.
My rights don't end where your fear begins.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @04:37PM
The record has been successfully corrected.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @07:44PM
You aren't factoring in the shitload of money people currently pay. So yes, M4A costs a ton of money, but the current system does too. A huge chunk of people just don't notice because the money comes straight out of their check, they get subsidies, or they are already on Medicare/Medicaid.
(Score: 2) by Runaway1956 on Saturday August 03 2019, @02:43PM
Saw some of that too. For the most part, the doctors were aging, at the point of maybe retiring anyway. They were just written off as retirees. But, some of them explained to patients and acquaintances exactly why they were retiring *NOW* as opposed to "in a few more years".
(Score: 1, Interesting) by Anonymous Coward on Sunday August 04 2019, @12:48AM
Of course not, that would mean that they'd no longer be allowed to gouge the patients. Either that or they're lousy doctors that are concerned about having to actually get results.
Doctors tend to care a lot about patients and their ability to get needed care. Sure, you've got incompetent assholes like the ones you're talking to that only care about money. But, doctors don't like watching patients get sick and die due to a lack of access to treatments. They'd prefer to worry about getting the diagnosis and treatment right rather than trying to figure out if the patient is actually going to be able to get the needed treatment. At least with socialized medicine denial of treatment is mostly based upon a statistical analysis of whether or not it makes sense rather than what it's going to do to the insurance company's bottom line.
Few people in countries with socialized medicine would give it up for what we have in the US. And for good reason, we pay a ton of money for mediocre results. And that's assuming you can afford it in the first place.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @05:46AM
the human tendency, at least in the US, to want to fleece money out of the government is very real and ongoing. providers, administrators, and patients routinely try to concoct schemes against Medicare and its patients in the US.
a live medical ID is more valuable than a credit card number because of this.