Weird, goverment run programs usually are the ones that make things inefficient.
Not sure if I can count on them to run such a large program.
Weird, goverment run programs usually are the ones that make things inefficient.
Not sure if I can count on them to run such a large program.
Apparently you misread "no group rates" as "everyone pays the same regardless of risk"
Go back and read it again. The OP was trying to imply that everyone of the same risk factor (ie same age, same gender; health risk is highly correlated to age) would pay the same. Why should a guy that is just as healthy as me pay less for insurance just because he's part of some group rate? If I purchase the same plan for myself, it costs more. Why am I forced to subsidize his health care costs?
It used to make sense because a group would have slightly less overhead, but we now live in a digital age. Most of that overhead doesn't need to exist anymore. Somehow insurance companies are still just a black hole for money, worse than any overinflated public works project in history.
People basically want to do away with the "pre-existing condition" nonsense that insurance companies like to pull in order to arbitrarily deny care. The hope is that a system run by the government would be immune to this kind of abuse, since it's run by the people and for the people. Insurance companies are run by private individuals for profit, so it's in their best interest to deny care even when it's covered by the plan you've purchased. If it requires that they make up some "pre-existing condition" when a surgery looks a little expensive, then so be it.
Cancer patients have been denied insurance payments out of the claim that the cancer probably existed prior to the patients' obtaining insurance x years ago, even if the patient never knew about it. That's kind of fucked up.
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There may be a few states that give pharmacists some minor control to adjust dosing without physician interaction, but to my knowledge there are none that allow pharmacists to write out scripts. Only Dr's, Nurse Practicianers, and a handful of specialized nursing positions(CRNA, and it's very limited) can do it.
And in the scale of problems in the healthcare industry, this has to rank towards the very bottom of reasons why we are where we are.
The main problem with health costs is that the consumer has been insulated from pricing. Someone else is paying the bill, so healthcare is largely treated by a buffet by both the consumers and the doctors. Doctors will bill what ever they can get away as the consumer is not footing the bill.
My wife had back surgery last year and I still have no idea how much it cost our insurance company. One of her docs prescribed a portable tens unit to help with back pain. As near as we can tell we could have purchased one for less than $200, but the company that provided it tried to bill the insurance company $1000 for it. And they also billed the insurance company $50 for the 9 volt battery to run the thing. This kind of stuff is happening industry wide.
Consumers need to know what things costs in order to bring medical prices back under control, until then we are caught in a upward price spiral.
My wife had back surgery last year and I still have no idea how much it cost our insurance company. One of her docs prescribed a portable tens unit to help with back pain. As near as we can tell we could have purchased one for less than $200, but the company that provided it tried to bill the insurance company $1000 for it. And they also billed the insurance company $50 for the 9 volt battery to run the thing. This kind of stuff is happening industry wide.
Consumers need to know what things costs in order to bring medical prices back under control, until then we are caught in a upward price spiral.
BeauJangles
Lifer
- Aug 26, 2001
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Care in the last several months of life is the most expensive. I'd much rather see a system that takes the decision-making about heroic measures away from the most biased group (immediate family) and puts it in the hand of a board of doctors. A simple cost-benefit analysis would save the healthcare system hundreds of millions of dollars.
Yeah, it's harsh, but life isn't fair and we shouldn't have to spend billions of dollars extending people's lives by weeks or months.
Yeah, it's harsh, but life isn't fair and we shouldn't have to spend billions of dollars extending people's lives by weeks or months.
Some remarks:
The AMA does not have a monopoly. The AMA is a relatively weak organization that only a minority of physicians are members of.
30% of healthcare is spent on the last several months of life. Healthcare should be rationed, and as a society we have to reach a decision that extending someone's life for several months in someone with terminal cancer or other serious illness is just not worth it. For example, it's not uncommon for someone with terminal cancer to spend months in the intensive care unit getting fed through a tube, having their blood work checked daily, being on a ventilator, getting expensive imaging tests, and consuming a large amount of human resources in terms of physicians, nurses, and other healthcare staff. As a physician I have seen people consume far more healthcare dollars in the last few days (and even hours) of their life than has been spent on me in my 29 years of life.
30% of healthcare spending is overhead, and many insurance companies make billions in profit per year. The highest paid executive made over 100 million dollars recently. Insurance does not actually contribute to the care of a patient, nor does it make it more efficient. Spending on this overhead should be drastically streamlined.
Physicians spend an incredible amount of time for comprehensive medical training, only to rely on specialists, physical therapists, dieticians, pharmacists, and other peripheral healthcare providers. Either we need to reduce the number of these healthcare providers, or we need to narrow the scope of physician education and shorten the length of training.
Americans have horrific health habits. The prevalence of obesity, diabetes, heart disease, smoking, and lack of exercise makes for an extremity expensive population. Obesity increases risks of countless other diseases, and increases the complication rate for virtually every surgery or hospital stay, which increases length of hospital stay and requires more costly procedures/tests. We as a country need to be more serious about physical fitness.
Finally, Americans need to shift their mentality away from healthcare being a buffet. What happens in a buffet is that people fill their plates, engorge themselves, and go home feeling sick. If we were faced with the cost of healthcare for each procedure or each service provided, we would stop wanting unnecessary MRI scans, unnecessary home nursing for minor dressing changes, unnecessary physical therapists because the patients are too lazy to get out of bed once in a while, etc. I'm not saying that home nursing, MRI scans, or physical therapists are unnecessary; but that they are currently being grossly over-utilized, mostly because we all think that someone else is paying the bill. If people paid for their own hospital stay, they would not want to stay in the hospital an extra day just because it's not convenient for their family members to pick them up, they would not need to pay people to get out of bed, and they would not need people to put a bandage on themselves.
The AMA does not have a monopoly. The AMA is a relatively weak organization that only a minority of physicians are members of.
30% of healthcare is spent on the last several months of life. Healthcare should be rationed, and as a society we have to reach a decision that extending someone's life for several months in someone with terminal cancer or other serious illness is just not worth it. For example, it's not uncommon for someone with terminal cancer to spend months in the intensive care unit getting fed through a tube, having their blood work checked daily, being on a ventilator, getting expensive imaging tests, and consuming a large amount of human resources in terms of physicians, nurses, and other healthcare staff. As a physician I have seen people consume far more healthcare dollars in the last few days (and even hours) of their life than has been spent on me in my 29 years of life.
30% of healthcare spending is overhead, and many insurance companies make billions in profit per year. The highest paid executive made over 100 million dollars recently. Insurance does not actually contribute to the care of a patient, nor does it make it more efficient. Spending on this overhead should be drastically streamlined.
Physicians spend an incredible amount of time for comprehensive medical training, only to rely on specialists, physical therapists, dieticians, pharmacists, and other peripheral healthcare providers. Either we need to reduce the number of these healthcare providers, or we need to narrow the scope of physician education and shorten the length of training.
Americans have horrific health habits. The prevalence of obesity, diabetes, heart disease, smoking, and lack of exercise makes for an extremity expensive population. Obesity increases risks of countless other diseases, and increases the complication rate for virtually every surgery or hospital stay, which increases length of hospital stay and requires more costly procedures/tests. We as a country need to be more serious about physical fitness.
Finally, Americans need to shift their mentality away from healthcare being a buffet. What happens in a buffet is that people fill their plates, engorge themselves, and go home feeling sick. If we were faced with the cost of healthcare for each procedure or each service provided, we would stop wanting unnecessary MRI scans, unnecessary home nursing for minor dressing changes, unnecessary physical therapists because the patients are too lazy to get out of bed once in a while, etc. I'm not saying that home nursing, MRI scans, or physical therapists are unnecessary; but that they are currently being grossly over-utilized, mostly because we all think that someone else is paying the bill. If people paid for their own hospital stay, they would not want to stay in the hospital an extra day just because it's not convenient for their family members to pick them up, they would not need to pay people to get out of bed, and they would not need people to put a bandage on themselves.
Because the AMA is the only authority to allow more medical schools they effectively have a monopoly on the supply of healthcare.
That's not quite accurate. Allopathic (MD) medical schools are accredited by the LCME (Liaison Committee on Medical Education). AAMC (Association of American Medical Colleges) and the AMA sponsor LCME secretaries, who decide on accreditation. The LCME's authority is not under the AMA, strictly speaking, and at best is only half controlled by the AMA. Furthermore, Osteopathic (DO) medical schools are accredited by the AOA (American Osteopathic Association). Most of the new medical schools are osteopathic (DO degree).
I do agree that the AMA has significant influence over the number of medical schools though.
Also keep in mind that the number of physicians in residency programs (training after the MD/DO degree) is about 30% more than the number of new graduates. The excess training spots are filled by foreign graduates, who are required to do residency training here to practice in the United States. The real bottleneck is in the number of residency training programs, not really in the number of medical schools.
The difficulty with increasing the number of residency spots is that physicians learn by practicing medicine under supervision. There are numerous requirements for completion of residency, and it's not a simple matter. You have to guarantee that someone in a residency training program has seen enough patients and encountered the appropriate variety of cases to be fully trained physicians. For example, in surgical training programs, for a program to increase a training spot, they have to demonstrate enough patient volume and surgical caseload that adding an extra spot won't have detrimental effects on the existing trainees (diluting their experience). This is very difficult.
It's not simply a matter of greedy physicians or conspiracies. As a matter of fact virtually all academic physicians (who comprise a large part of the AMA, AAMC, etc) openly acknowledge the physician shortage and have aggressively worked to increase the number of medical students and residency programs. In fact several new MD programs have opened and more are awaiting accreditation, while even more DO programs have also opened.
Anubis
No Lifer
So oh brilliant one. Tell me what Medicare is, or better yet, tell me what the Canadian system is if it isn't one giant HMO? You're about as bright as the one you replied to.
I don't know the exact numbers, but if you want to reduce costs you can start with these factors:
- Reduce admin costs (we're absurdly high in the US)
- Reduce end of life costs (ditto)
- Reduce "preventative medicine" by limiting liability (ditto)
I bet you could get at least 30-40% savings with those three items alone.
Regardless of all the details, fact remains that the medical profession has not reacted to the surge in demand for their services with an increase planning for the supply. They've seen their wages soar so it's not quite in their interest to do so.
On a macro level, medicine is VERY protective and anti-competitive.
Anubis
No Lifer
10s of millions
The hospitial in my town does not actually own a MRI, one comes in twice a week on a truck (this is not uncommon) because they cost like 50ish million and small hospitials cant afford them
Your dreaming if you think that physician salaries have soared. Reimbursements haven't even kept up with inflation. Most physician are actually making less today then they did 10 years ago.
I'm all for opening up more positions for medical students and more residencies, but you will have to maintain current requirements and standards or the quality of physicians graduated will suffer.
As for expecting to spend less on physician salaries, saving would be minimal while the impact on quality would be dramatic. Think if you are in the top 10% of your class and have the option for job A that pays 100K or job B that pays 50K, where do you think the best and the brightest will go.
I for one don't want Joe the plumber doing my vasectomy.
And don't forget that they might bill $2000 and accept $200 as payment in full. The cash price is exaggerated because of the discounts in the contracts that they hold with each insurance company. Most hospitals are now giving a 35% discount to anyone who pays cash.
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Actually, CT's are pretty cheap - $500-$1500 or so. It's MRI's that are pricey. That start at $1000 and go up to several thousand.
A current tech CT scanner is probably in the ballpark of around 3.5 million for a facility to buy outright. But then you also have to figure in the costs of the rooms, PACS storage system, radiologist and various other specialist interpretations, ect.
Anubis
No Lifer
Its worse then not just keeping up with inflation. you have inflation + cost of living + higher malpractice insurance costs across the board + 50% less reimbursement (it gets lower every year)
Doctors have honestly been fucked over more then most realize. And yes alchemize HMOs are a massive part of the issue; they are the single largest reason you see a lack of doctors in many areas today as well as the lack of personal patient care. Docs don?t go to school for 4-10 years longer then everyone else to not get paid.
20 years ago if your insurance got billed 2K for something, the doc got paid 2K, today if you bill for 2K the HMO basically says we are only going to pay you 800$ and go fuck yourself for the $1200 we are not going to give you.
.
Someone mentioned that group plans are cheaper to administer, can you elaborate. This is one area I do not get. Many people cannot afford to get health insurance because of high premiums for non-group members.
Also it seems that if we took the benifits packages many people get and turn that into a monitary benifit, the disparity between those jobs with and without benifits would be more appearent to the american people.
Also it seems that if we took the benifits packages many people get and turn that into a monitary benifit, the disparity between those jobs with and without benifits would be more appearent to the american people.
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