Big Medicine driving up prices?

[Wreckem]

That wasn't my focus. I think most of the USA (those that don't live in California, Arizona and Texas) would be shocked to learn how much money is lost to illegals in ERs every year.

On a whole its about 20% of the costs related to the uninsured.

 

[Darwin333]

I will throw this out there for yall to ponder. This surgical center is strictly cash only and cash upfront. The do not accept insurance, medicaid, medicare or anything else other than cash (or I assume credit, checks, etc..) and you are required to pay upfront. Now here is the interesting part, first of all you can go to their website and see EXACTLY what the price for a certain procedure and on average they are anywhere between 1/3 and a full 1/5 cheaper on their services. They have an impeccable reputation and track record so they aren't skimping on quality at all.

This is from their home page:

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. As more and more patients find themselves paying more and more out of pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing.

Surgery Center of Oklahoma

Personally, I think this shows just how extreme the much cost shifting is going on in the healthcare industry.

 

[Matt1970]

Wow, kind of I ronic thinking that it drives the cost of healthcare up when one entity starts being in charge rather than many....

 

[Ausm]

There are only 40 posts in the thread.... Is it that hard to look? Post #16

Yes....

 

[Slew Foot]

I will throw this out there for yall to ponder. This surgical center is strictly cash only and cash upfront. The do not accept insurance, medicaid, medicare or anything else other than cash (or I assume credit, checks, etc..) and you are required to pay upfront. Now here is the interesting part, first of all you can go to their website and see EXACTLY what the price for a certain procedure and on average they are anywhere between 1/3 and a full 1/5 cheaper on their services. They have an impeccable reputation and track record so they aren't skimping on quality at all.

This is from their home page:



Surgery Center of Oklahoma

Personally, I think this shows just how extreme the much cost shifting is going on in the healthcare industry.

Those prices arent exactly cheap and are on par with what most insurances pay. The big kicker is this:

Any hardware or implants necessary for completion of the procedure (plates and screws, e.g. for orthopedic procedures). This price information will be provided prior to surgery but subsequent to the surgical consultation. Our experienced surgical staff knows with almost certainty what will be needed to complete your surgery and this hardware or implants will be provided to you at invoice cost without any markup whatsoever. Copies of the invoices will be provided to you.




The implants can easily double the costs listed.

 

[Darwin333]

Those prices arent exactly cheap and are on par with what most insurances pay. The big kicker is this:

Any hardware or implants necessary for completion of the procedure (plates and screws, e.g. for orthopedic procedures). This price information will be provided prior to surgery but subsequent to the surgical consultation. Our experienced surgical staff knows with almost certainty what will be needed to complete your surgery and this hardware or implants will be provided to you at invoice cost without any markup whatsoever. Copies of the invoices will be provided to you.




The implants can easily double the costs listed.

Did you not read what you just posted?

this hardware or implants will be provided to you at invoice cost without any markup whatsoever. Copies of the invoices will be provided to you.

That means ZERO profit made off of those implants. And I have seen some procedures cost $8K, listed upfront for all to see, whose "Average cost" in some places are quite literally $80K,

Show me that ANY of their prices are above the "normal" systems prices (with all cost shifting included).

I googled the average price per procedure for quite of few of the ones they list and it varied greatly by location (by 100's of percent no less) but the overall average was generally much higher all the way up to absurdly higher. Besides, are you trying to say they are in business because of stupid people that can afford to pay for stuff like that upfront?

 

[Acanthus]

The democrats could have fixed that in the healthcare bill if they weren't in the pockets of the pharmaceutical companies themselves.

The original draft of the healthcare bill removed the price fixing immunity for pharmaceutical companies. It was removed in negotiations.

 

[Acanthus]

On a whole its about 20% of the costs related to the uninsured.

Well that whole argument will go out the window in a couple of years when we hit 99%+ coverage. I wonder what the price disparity excuse will be then?

 

[Dulanic]

Wow, kind of I ronic thinking that it drives the cost of healthcare up when one entity starts being in charge rather than many....

Yet this is a private company.... they should be allowed to do as they please no? Free market? 😵 You flip flop logic makes heads spin. Did you learn tactics from Romney? This is a private company attempting to create a local monopoly in healthcare in order to sky rocket pricing....

This is happening around the country... and you would think it would cut prices since the different offices should be more efficient. However, it is quite the opposite. Just as one example, I had to get 2 MRI's in 2 years. The first one cost me 20% which ended up being $72 after the negotiated rate. Then this location got bought out by the local for profit hospital group. The cost tripled and the negotiated rate doubled and the next one cost me $148 for the same MRI and the only change was who now owned the location.

The largest scam out of all of this is that the places won't tell you what it is going to cost you ahead of time. It is kind of a guessing game. They can tell me their billed rate, but they won't tell you their negotiated rate. All they will say is they don't know until the claim returns to them from the insurance company. How the fuck are people supposed to make smart decisions in this fucked up 100 payer system?

 

[Slew Foot]

Did you not read what you just posted?



That means ZERO profit made off of those implants. And I have seen some procedures cost $8K, listed upfront for all to see, whose "Average cost" in some places are quite literally $80K,

Show me that ANY of their prices are above the "normal" systems prices (with all cost shifting included).

I googled the average price per procedure for quite of few of the ones they list and it varied greatly by location (by 100's of percent no less) but the overall average was generally much higher all the way up to absurdly higher. Besides, are you trying to say they are in business because of stupid people that can afford to pay for stuff like that upfront?

hey dumbshit, the implants cost direct from the company is in the range of 500 per screw, 4000 per allograft, 8000 per plate etc.... the cost you see advertised by places has zero bearing on what an insurance company pays out. usually the amount is lower than what these people are charging.

 

[Ausm]

Except the problem is they did lack the balls to make a move rectifying the health system. Arguably what they really did was make it more fucked up.

Considering that as per the OP they have never expressed any desire to fix the root cause of the issue this is not surprising.

Have any data that shows this is true especially when the majority of the ACA will be implemented in 2014 and beyond?

 

[Darwin333]

Yet this is a private company.... they should be allowed to do as they please no? Free market? 😵 You flip flop logic makes heads spin. Did you learn tactics from Romney? This is a private company attempting to create a monopoly in healthcare in order to sky rocket pricing....

The biggest problem is NOT the free market it is the lack of a free market due to .gov intervention while still trying to pretend that it is a free market.

This is happening around the country... and you would think it would cut prices since the different offices should be more efficient. However, it is quite the opposite. Just as one example, I had to get 2 MRI's in 2 years. The first one cost me 20% which ended up being $72 after the negotiated rate. Then this location got bought out by the local for profit hospital group. The cost tripled and the negotiated rate doubled and the next one cost me $148 for the same MRI and the only change was who now owned the location.

Is it a publicly traded group? If so we can find out exactly what their profits are but it just illustrates the larger issue. If a big group that owns many hospitals purchases the place they have a fuckload of cost shifting that must take place that a smaller, imaging only type business, doesn't have nearly the amount of. To the big hospital, it allows them to shift costs around more and lower each individual "cost shifting burden" but which one could argue is helpful. At the same time you got boned which isn't.

I know you are probably going to scream single payer but until we as a nation get comfortable with honest to goodness .gov ran "death panels", which we absolutely must have if we are to afford single payer its just not going to happen.

The largest scam out of all of this is that the places won't tell you what it is going to cost you ahead of time.

A-fucking-men! That is illegal in just about every single other business in the nation yet the healthcare providers get special treatment, mostly because the .gov forces them by law to engage in cost shifting (something else that SHOULD be illegal).



As a side thought, I wonder why the smaller companies are selling out? They can obviously get away with raising their prices so I can't imagine they aren't profitable. Hell, sounds like they could increase their profit 10 or 15% and everyone would still be way happier.

 

[Ausm]

The original draft of the healthcare bill removed the price fixing immunity for pharmaceutical companies. It was removed in negotiations.

That's the same time when President Obama nixed the Public option too which really fucking pissed off the Progressives.

 

[Darwin333]

hey dumbshit, the implants cost direct from the company is in the range of 500 per screw, 4000 per allograft, 8000 per plate etc.... the cost you see advertised by places has zero bearing on what an insurance company pays out. usually the amount is lower than what these people are charging.

Actually, I wasn't using costs "advertised" since very few hospitals will even give you a cost upfront over the phone. I was using the average cost paid by insurance and medicare. And if the best you have is some made up bullshit about how much you think it costs with absolutely no backup whatsoever.........

 

[Darwin333]

The original draft of the healthcare bill removed the price fixing immunity for pharmaceutical companies. It was removed in negotiations.

And this is exactly why:

http://www.nytimes.com/2009/08/06/health/policy/06insure.html

Thanks Obama.....

That's the same time when President Obama nixed the Public option too which really fucking pissed off the Progressives.

From the same article, maybe this has something to do with why it was nixed? Pure speculation of course but perhaps it was part of their deal or maybe he just figured there was to much opposition to it....


"The drug industry trade group, the Pharmaceutical Research and Manufacturers of America, also opposes a public insurance plan."

P.S. Billy Tauzin is the asshole that was front and center of Medicare part D and the huge ass giveaway to big pharma. After Medicare part D passed he either didn't run again or might have even resigned his seat to become the highest paid pharma lobbyist ever. He is a fucking huge pile a shit and I hope he dies in a fucking fire.

 

[Ausm]

And this is exactly why:

http://www.nytimes.com/2009/08/06/health/policy/06insure.html

Thanks Obama.....




From the same article, maybe this has something to do with why it was nixed? Pure speculation of course but perhaps it was part of their deal or maybe he just figured there was to much opposition to it....


"The drug industry trade group, the Pharmaceutical Research and Manufacturers of America, also opposes a public insurance plan."

P.S. Billy Tauzin is the asshole that was front and center of Medicare part D and the huge ass giveaway to big pharma. After Medicare part D passed he either didn't run again or might have even resigned his seat to become the highest paid pharma lobbyist ever. He is a fucking huge pile a shit and I hope he dies in a fucking fire.

If we had the Public option it would force the the Private insurance companies to be competitive and besides who the fuck would even want Private insurance if there was a Public option? I find it funny how the Rightists seem oblivious to the specifics of the Medicare Part D "Gift" to Big pharma that we are paying out of the ass for.

 

[TechAZ]

hey dumbshit, the implants cost direct from the company is in the range of 500 per screw, 4000 per allograft, 8000 per plate etc.... the cost you see advertised by places has zero bearing on what an insurance company pays out. usually the amount is lower than what these people are charging.

And your health facility negotiates the prices (see dictates) to what the sales reps can sell those for. Surgical centers/hospitals always mark up the implant costs, they are not sold to the patient at cost.

BTW, those prices that you listed are funny. Those are costs for spinal fusions, not typical ortho cases...unless you are mistaken and pulling out marked up prices as those are not "at cost" from the sales reps.


The health care system is so inflated and messed up. Products, supplies, service contracts for machines, everything is expensive to the health care facility. It's not just "Big Medicine", it's everything.

 

[Ausm]

And your health facility negotiates the prices (see dictates) to what the sales reps can sell those for. Surgical centers/hospitals always mark up the implant costs, they are not sold to the patient at cost.

BTW, those prices that you listed are funny. Those are costs for spinal fusions, not typical ortho cases...unless you are mistaken and pulling out marked up prices as those are not "at cost" from the sales reps.


The health care system is so inflated and messed up. Products, supplies, service contracts for machines, everything is expensive to the health care facility. It's not just "Big Medicine", it's everything.

I boil it down to Healthcare for profit is a travesty.....

 

[Darwin333]

If we had the Public option it would force the the Private insurance companies to be competitive and besides who the fuck would even want Private insurance if there was a Public option? I find it funny how the Rightists seem oblivious to the specifics of the Medicare Part D "Gift" to Big pharma that we are paying out of the ass for.

The "rightists" also don't like to admit that their side passed the largest expansion of entitlements in decades which would be the same Medicare Part D. But I am not going to let the other side off the hook either because Obama made basically the same bad deal (while including some huge gifts to them and a few sizable costs to be fair).

And frankly, I know the health insurance companies have been made into the bad guys lately but frankly it doesn't seem like they are the ones that are truly the driving force between our absurdly high healthcare costs. They might account for a very small part of the increase but it seems like the lions share is from the service, supply, and pharma side.

 

[Ausm]

The "rightists" also don't like to admit that their side passed the largest expansion of entitlements in decades which would be the same Medicare Part D. But I am not going to let the other side off the hook either because Obama made basically the same bad deal (while including some huge gifts to them and a few sizable costs to be fair).

And frankly, I know the health insurance companies have been made into the bad guys lately but frankly it doesn't seem like they are the ones that are truly the driving force between our absurdly high healthcare costs. They might account for a very small part of the increase but it seems like the lions share is from the service, supply, and pharma side.

I agree with this 100% and their lobbyist must have greased quite a few palms to get left out of the mix. 😉

 

[FerrelGeek]

The Republicons love reaming Americans on drug prices that why they have consistently blocked all Legislation to negotiate drug prices for Medicare which would save BILLIONS of dollars.

Another ausum post by the forum's pet liberal rage monster.

The democrats could have fixed that in the healthcare bill if they weren't in the pockets of the pharmaceutical companies themselves.

This. ausum is pathologically incapable of admitting that his side is just as corrupt as he rages over the other side. Classic Freudian projection. The mark of an emotionally immature individual.

 

[blackangst1]

as long as we dont have any price transparency, this is going to happen.

I guess it was too much to ask to put such a simple reform into ACA....

This. Full transparency will fix alot of cost issues. And it will work even with the abomination known as obamacare. If youre interested in this Google for Steve Burd's views and ideas for healthcare. He has even testified to congress about this idea. Of course, it fell on deaf ears.

The democrats could have fixed that in the healthcare bill if they weren't in the pockets of the pharmaceutical companies themselves.

And this. Partisan hacks like Ausm cant see the obvious in front of them.

 

[Slew Foot]

And your health facility negotiates the prices (see dictates) to what the sales reps can sell those for. Surgical centers/hospitals always mark up the implant costs, they are not sold to the patient at cost.

BTW, those prices that you listed are funny. Those are costs for spinal fusions, not typical ortho cases...unless you are mistaken and pulling out marked up prices as those are not "at cost" from the sales reps.


The health care system is so inflated and messed up. Products, supplies, service contracts for machines, everything is expensive to the health care facility. It's not just "Big Medicine", it's everything.

hey dumbasses, I'm a CFO of a hospital, i know exactly what all this shit costs.

 

[TechAZ]

hey dumbasses, I'm a CFO of a hospital, i know exactly what all this shit costs.

Tell me what kind of plate costs 8k and from who. You're pulling that out of your ass. I have worked with surgical sales reps and around surgery for a long time. If you really are a CFO than you know that YOU dictate how much implants cost.

 

[Dulanic]

As a side thought, I wonder why the smaller companies are selling out? They can obviously get away with raising their prices so I can't imagine they aren't profitable. Hell, sounds like they could increase their profit 10 or 15% and everyone would still be way happier.

That is a easy thought to answer. They are losing business in that all the doctor offices are being bought up by these large medical groups. When this happens, the smaller places lose business because all the referrals they sent to the smaller imaging places are no longer happening. I think part of that is addressed in the OP article...yup found it...

In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

How can you compete on a level playing field when the majority of the doctors who sent business your way are now employed by a company who offers the same product you do... at a much higher price. Of course, the patients don't know it is a higher price because they aren't told. My doctors try to pull the same shit and I push back. Thankfully my health insurance shows me estimated cost by location so I get a "basic" idea as to what the cost will be. Unfortunately, it isn't always accurate as it is based on the last claim for that service received from that location.... which can be rather skewed it seems. According to my health insurance my MRI at my currently place will cost $148... yet it would cost me $1000 out of pocket from a hospital a few miles away. I don't honestly believe it would be that high, it was probably due to some other service thrown in the same claim.