Choking on Obamacare

[Ausm]

They charge that much because a 3rd party is footing the bill most of the time. The is a problem that exists all over the medical industry.

What third party? My oldman has the means to pay it all and he does.

 

[werepossum]

LMAO you sound like you wrote that Right Wing commercial demonizing the Affordable Care Act that Republican Super PACS are plastering on TV. 🙂

With the 1.5 Billion dollars this Bill has saved Seniors on their Meds and the 2.5 million children who now can get healthcare insurance good luck getting this Bill repealed.

Here is a caveat that is bound to make you go fetal, I would say 3/4 of the changes implemented by the Affordable Care Act have yet to be instituted.

By stating the reality? That would imply that this "right wing commercial" is absolutely factual. And I'm well aware that most of the changes of ACA have yet to be implemented; I'm also well aware that the act is very ill-defined in spite of its length, with most of it merely empowering a new huge government bureaucracy. That's why I've said that progressives should be happy with Obama; he has gotten passed something that enables them to slowly destroy the 50% of health care still within the private sector, looting the insurance companies and lowering the level of care so that when we do inevitably got a a single payer government system, people will remember the system broken rather than the system working.

 

[werepossum]

Not sure what ACA has to do with CEO's of nursing home chains making more money in a month than you or I will make in our lives.

LOL Yes, clearly the obvious and only answer is to render these chains leaderless so that we may celebrate getting nursing home care down to $332.90 a day.

 

[actuarial]

Insurance of any type is a necessary evil; in and of itself it creates no additional wealth for the additional expenditure.

While this may not be true in terms of first order effects, I firmly believe universal medical insurance can have positive second order effects.

Spreading risk can help empower those to strive out on their own who otherwise wouldn't have. The biggest problem I see with the US medical system is that for many families once you get some kind of major illness, it severely limits your future employment opportunities because you have to avoid being denied medical insurance for pre-existing conditions.

Now, as an actuary I know that denying pre-existing conditions is an economic reality for private business. It is not a reality for true universal medical care.

 

[Ausm]

By stating the reality? That would imply that this "right wing commercial" is absolutely factual. And I'm well aware that most of the changes of ACA have yet to be implemented; I'm also well aware that the act is very ill-defined in spite of its length, with most of it merely empowering a new huge government bureaucracy. That's why I've said that progressives should be happy with Obama; he has gotten passed something that enables them to slowly destroy the 50% of health care still within the private sector, looting the insurance companies and lowering the level of care so that when we do inevitably got a a single payer government system, people will remember the system broken rather than the system working.

Maybe in the tiny little world you live in. 🙂

 

[Ausm]

By stating the reality? That would imply that this "right wing commercial" is absolutely factual. And I'm well aware that most of the changes of ACA have yet to be implemented; I'm also well aware that the act is very ill-defined in spite of its length, with most of it merely empowering a new huge government bureaucracy. That's why I've said that progressives should be happy with Obama; he has gotten passed something that enables them to slowly destroy the 50% of health care still within the private sector, looting the insurance companies and lowering the level of care so that when we do inevitably got a a single payer government system, people will remember the system broken rather than the system working.

Another nice Republican regurgitation for weak minded /ill informed sheep...do you realize that both The Medicare and SS Bills had "more" pages then this Bill and the Repug constituents seem to love their benefits.

 

[jstern01]

"According to the most recent estimate from The Centers for Medicare and Medicaid Services (CMS), overall U.S. healthcare spending in 2009 was $2.5 trillion. CMS reports that $505 billion accounts for physician clinical services. According to data from Medical Group Management Association (MGMA), physician compensation accounts for 37 percent of total collections, or $186 billion (7.5 percent of total U.S. healthcare spending)"

Meanwhile malpractice premiums have risen.

http://www.cbo.gov/doc.cfm?index=4968&type=0

So where are we supposed to save the money. Every physician in the US could give his services away for free and it wouldnt save enough to offset the costs.

Technology is the biggest cost of medical care

http://www.cbo.gov/ftpdocs/89xx/doc8947/MainText.3.1.shtml

And the there are only two ways to curb the technological costs.
1. tort reform will decrease defensive medicine.
2. change the american demand for unnecessary tests. - not an easy task, because americans have become accustom to getting what they want and not listening or respecting the advice of their physician.

The next biggest cost is Financing.
You wouldnt use your credit card if everytime you did you got charged an extra 30%. We need to force some efficency into the financing system. One by minimizing its use through HSA's and second by reistablishing competition among carriers.

While tort reform and major payouts make up less then 6/10 of 1% of the cost of our healthcare, the insurance companies again take advantage of this to generate enormous profits for their share holders.

http://www.citizen.org/documents/NPDB_Report_200907.pdf

How to fix this perceived issue? Get rid of the bad doctors. The fact that medical boards are reluctant except when highly publicized cases to strip a doctor of their licenses is a big part of the issue. Since most of the malpractice lawsuits are by a small percentage of the doctors, stripping them of their license to practice, while in the short run may not lower rates, in the long run would go a long way to them making the case of fixing malpractice insurance.

Another approach is to just admit when mistakes are made, and deal openly with the problem. This article has a good explanation of what the impact of such a policy would be.

http://www.healthbeatblog.org/2008/05/medical-malpr-1.html

 

[Hayabusa Rider]

While this may not be true in terms of first order effects, I firmly believe universal medical insurance can have positive second order effects.

Spreading risk can help empower those to strive out on their own who otherwise wouldn't have. The biggest problem I see with the US medical system is that for many families once you get some kind of major illness, it severely limits your future employment opportunities because you have to avoid being denied medical insurance for pre-existing conditions.

Now, as an actuary I know that denying pre-existing conditions is an economic reality for private business. It is not a reality for true universal medical care.

http://www.healthcare.gov/news/factsheets/2011/12/pcip12092011a.html

 

[werepossum]

While this may not be true in terms of first order effects, I firmly believe universal medical insurance can have positive second order effects.

Spreading risk can help empower those to strive out on their own who otherwise wouldn't have. The biggest problem I see with the US medical system is that for many families once you get some kind of major illness, it severely limits your future employment opportunities because you have to avoid being denied medical insurance for pre-existing conditions.

Now, as an actuary I know that denying pre-existing conditions is an economic reality for private business. It is not a reality for true universal medical care.

I think universal health insurance/universal health care has many positive first and second order effects. The thing it CAN'T do is deliver the same quality of care to more people for the same amount of money. It also has some negative first and second order effects. In this case, the negative second order effects are essentially the same as the positive effects - empowering people to go out on their own. One of the left's positives - allowing people more security to become performance artists or bongo soloists or holistic telephone aura sterilizers - is to those of us on the right actually a negative because some of these people would otherwise be doing useful work. Not brain surgery or rocket science, obviously, but many of these would-be wannabees are employable as convenience store clerks, faster food workers, and janitors. But I suspect you are right that the net second order effect would be positive. Right now one needs a significant pile of cash to go out on one's own, and with any moderately serious pre-existing condition one needs a spouse with family health insurance. Affordable personal health insurance (by spreading the risk among all Americans) would make small business dreams that much easier to realize.

Maybe in the tiny little world you live in. 🙂

It's the same tiny little world we all live in, as evidenced by your inability to refute my statement. Anyone can look up the history of the bill online, and I have every confidence in your ability to do so - or at least find a conservative able to do it for you. 😉

 

[mattpegher]

While tort reform and major payouts make up less then 6/10 of 1% of the cost of our healthcare, the insurance companies again take advantage of this to generate enormous profits for their share holders.

http://www.citizen.org/documents/NPDB_Report_200907.pdf

How to fix this perceived issue? Get rid of the bad doctors. The fact that medical boards are reluctant except when highly publicized cases to strip a doctor of their licenses is a big part of the issue. Since most of the malpractice lawsuits are by a small percentage of the doctors, stripping them of their license to practice, while in the short run may not lower rates, in the long run would go a long way to them making the case of fixing malpractice insurance.

Another approach is to just admit when mistakes are made, and deal openly with the problem. This article has a good explanation of what the impact of such a policy would be.

http://www.healthbeatblog.org/2008/05/medical-malpr-1.html

Its not the cost of malpractice insurance or payouts that is the issue. While my malpractice cost nearly 90K/year (no settlements). The cost of trying a case is about 200K/defendent.
It really is the extra studies done unnecessarily that drive up costs.
Again I will say that malpractice insurance premium cost between 1 and 2% (dep on sources)
and Physician compensation accounts for 8%. So what cost so much?

Meds - sure there can be some savings but we may need to shift more fed money to R&D if we eliminate some of the financial incentive for pharma to do it.

Hospitalization - Very manpower intensive. Between staff and ancillary most hospital are in the red if they get less than $1000/day even if they dont do anything else.

Technology - Congressional Budget office has stated that technology is the single greatest driver of healthcare expenditures and will likely only increase in the next 10 years.
- I can easily spend about $10,000 of the hospitals equipement, meds and manpower, in 1 hour of Advanced Cardiac Life Support.

Long term care - As stated above it probable costs a NH at least 200/day minimum to care for an elderly incapacitated person. 200/day x 365days/year = $73000/year

The key to UHC is removing the 30% skimmed of the top by insurance companies.

To the best of my knowledge, there isnt a health care provider in the country that is making a killing. And the vast majority of hospitals rely on at least 20% of their operating budget from charitable donations.

 

[actuarial]

http://www.healthcare.gov/news/factsheets/2011/12/pcip12092011a.html

As I was typing that post I was thinking there was something with regards to that in Obamacare.

Those numbers you linked were crazy low in terms of participation, but it is new. I wonder how they go about forcing a private company to offer affordable private insurance to someone and have a negative expected outcome from the part of the insurer and what the long term effects on the market are.

 

[jstern01]

Its not the cost of malpractice insurance or payouts that is the issue. While my malpractice cost nearly 90K/year (no settlements). The cost of trying a case is about 200K/defendent.
It really is the extra studies done unnecessarily that drive up costs.
Again I will say that malpractice insurance premium cost between 1 and 2% (dep on sources)
and Physician compensation accounts for 8%. So what cost so much?

Meds - sure there can be some savings but we may need to shift more fed money to R&D if we eliminate some of the financial incentive for pharma to do it.

Hospitalization - Very manpower intensive. Between staff and ancillary most hospital are in the red if they get less than $1000/day even if they dont do anything else.

Technology - Congressional Budget office has stated that technology is the single greatest driver of healthcare expenditures and will likely only increase in the next 10 years.
- I can easily spend about $10,000 of the hospitals equipement, meds and manpower, in 1 hour of Advanced Cardiac Life Support.

Long term care - As stated above it probable costs a NH at least 200/day minimum to care for an elderly incapacitated person. 200/day x 365days/year = $73000/year

The key to UHC is removing the 30% skimmed of the top by insurance companies.

To the best of my knowledge, there isnt a health care provider in the country that is making a killing. And the vast majority of hospitals rely on at least 20% of their operating budget from charitable donations.

What about we start looking at why hospitals all try to compete with each other, and in the end raise the price of health care. Perfect example is here in Orlando. We currently have a level 1 neonatal facility, which is struggling to get by because their occupancy rate is low. Now Neumour's is building a brand new facility. Do we really need 2 state of the art facilities in a city with under a million people?

Honestly I have little sympathy for private hospital corporations, that are only looking to make a profit. If they are dumb enough to build a new facility into a depressed market then they deserve to lose money. But do not artificial inflate the cost of my care because they can not make a profit.

 

[actuarial]

I think universal health insurance/universal health care has many positive first and second order effects. The thing it CAN'T do is deliver the same quality of care to more people for the same amount of money.

I agree if it's a true free market system, but that has never and probably will never exist. I think single payer in the US would improve outcomes AND lower costs, but that's a completely different economic debate.

It also has some negative first and second order effects. In this case, the negative second order effects are essentially the same as the positive effects - empowering people to go out on their own. One of the left's positives - allowing people more security to become performance artists or bongo soloists or holistic telephone aura sterilizers - is to those of us on the right actually a negative because some of these people would otherwise be doing useful work. Not brain surgery or rocket science, obviously, but many of these would-be wannabees are employable as convenience store clerks, faster food workers, and janitors. But I suspect you are right that the net second order effect would be positive. Right now one needs a significant pile of cash to go out on one's own, and with any moderately serious pre-existing condition one needs a spouse with family health insurance. Affordable personal health insurance (by spreading the risk among all Americans) would make small business dreams that much easier to realize.

I think you have some huge stereotyping in there (that the left want more people to become bongo soloists), but I don't know how much of that will actually happen. Trust me - even in Canada where there is universal health care there's not hoards of people trying to make it as a holistic telephone aura sterilizer, and those people still have significant economic incentives not to be deadbeats.

At least in Canada, the downside risk (bankruptcy) is much more within your own control and much less subject to the whims of statistical variation.

 

[Ausm]

It's the same tiny little world we all live in, as evidenced by your inability to refute my statement. Anyone can look up the history of the bill online, and I have every confidence in your ability to do so - or at least find a conservative able to do it for you. 😉

LMAO So you want me to refute a Republican talking point regurgitation?? Give me a break you wouldn't read it anyway but what we can take from our conversation is that we are in complete disagreement. I have a feeling your Republican talking points on the Affordable Care Act will be just that talking points sort like Trickle on Economics.

 

[werepossum]

While tort reform and major payouts make up less then 6/10 of 1% of the cost of our healthcare, the insurance companies again take advantage of this to generate enormous profits for their share holders.

http://www.citizen.org/documents/NPDB_Report_200907.pdf

How to fix this perceived issue? Get rid of the bad doctors. The fact that medical boards are reluctant except when highly publicized cases to strip a doctor of their licenses is a big part of the issue. Since most of the malpractice lawsuits are by a small percentage of the doctors, stripping them of their license to practice, while in the short run may not lower rates, in the long run would go a long way to them making the case of fixing malpractice insurance.

Another approach is to just admit when mistakes are made, and deal openly with the problem. This article has a good explanation of what the impact of such a policy would be.

http://www.healthbeatblog.org/2008/05/medical-malpr-1.html

You completely missed his point, which was that fear of litigation drives expensive diagnostic tests which drive up the cost of health care. Of the malpractice suits with which I am personally familiar, only three dealt with an actual malpractice incident. (One involved removing the wrong leg, one the wrong eye, and one giving a drug to which the patient was known to be allergic. I've known some other cases in which people did not sue that were the result of misjudgments or misdiagnosis, but not necessarily a bad physician or malpractice.) All the rest stemmed from unforeseeable drug interactions, patient misbehavior, or asymptomatic diseases in which a particular test possibly could have determined the underlying problem, but the symptoms presented did not logically call for that test. For instance, someone presenting with sinus pain and inflammation might be determined to have an underlying heart infection by using an electrocardiogram, MRA and C/T scan, but there is no reason to suspect that someone apparently presenting with a bad sinus infection also has an underlying heart infection. Nor could any system of health care survive the costs of running such tests for everyone presenting with a sinus infection, even if you eliminated every executive position in the country.

And not every grave injury is malpractice. I knew a diabetic man whose chart was clearly marked with his allergy to penicillin, yet the hospital gave him penicillin. He lost both legs. Clearly that is malpractice - it's an avoidable (though honest) mistake in reading a patient's chart - and he rightly won his malpractice suite. On the other hand, when my cousin's son had to have heart surgery at age three he was given a child's dose of anesthetic, then a second child's dose, then an adult dose, then a second adult dose. Consequently he not only remained in a coma for two weeks, but had some brain damage and literally had his mind wiped - he had to relearn potty training, walking, talking, everything, and he was never able to do math. My cousin didn't sue because it was an honest mistake, but he would no doubt have won. It's bad professional judgment, but not necessarily malpractice as different people do react differently to drugs. Then we have a third kind of case - where the patient presents with symptoms not consistent with something that soon after kills him, like my example of a patient visiting the emergency room with a bad sinus infection and dieing few days later from an undiagnosed heart infection - clearly not malpractice. However all three of these cases are equally likely to make you and/or your lawyer wealthy.

Similarly, everyone with experience in professional liability insurance knows that if you admit culpability - at any level - you have removed your insurance protection. Admit you did something wrong and you have damaged the insurance carrier's ability to defend you, so by their contract they are relieved of the responsibility to try doing so. A doctor may know he screwed up, and may honestly want to admit it, but if he does so the patient can't collect on his malpractice insurance and therefore would be limited to the doctor's assets - which for a young doctor may well be negative because of his loans. (I'm going by professional engineer liability insurance here; there may be regulations that prevent medical malpractice insurance from doing the same.)

As long as malpractice suits remain a highly lucrative for-profit business, doctors will continue to practice defensive medicine and doctors and hospitals will refuse to admit any culpability.

 

[mattpegher]

What about we start looking at why hospitals all try to compete with each other, and in the end raise the price of health care. Perfect example is here in Orlando. We currently have a level 1 neonatal facility, which is struggling to get by because their occupancy rate is low. Now Neumour's is building a brand new facility. Do we really need 2 state of the art facilities in a city with under a million people?

Honestly I have little sympathy for private hospital corporations, that are only looking to make a profit. If they are dumb enough to build a new facility into a depressed market then they deserve to lose money. But do not artificial inflate the cost of my care because they can not make a profit.

How does competition, increase the price of healthcare?
Sure hospital systems compete for patients, and try to keep patients within their system for all kinds of services. However once a system is large enough to "build a new neonatal facility" they are already large enough to negotiate strongly with the insurance companies.

Large systems add facilities to capture market share but that doesnt increase the cost. If anything it increases competition and options for insurance companies to send patients elsewhere, decreasing the amount they are willing to pay for a service (the contracted rate).

 

[werepossum]

I agree if it's a true free market system, but that has never and probably will never exist. I think single payer in the US would improve outcomes AND lower costs, but that's a completely different economic debate.

I think you have some huge stereotyping in there (that the left want more people to become bongo soloists), but I don't know how much of that will actually happen. Trust me - even in Canada where there is universal health care there's not hoards of people trying to make it as a holistic telephone aura sterilizer, and those people still have significant economic incentives not to be deadbeats.

At least in Canada, the downside risk (bankruptcy) is much more within your own control and much less subject to the whims of statistical variation.

Agreed, there was intentionally a huge amount of stereotyping. But it's not far from Pelosi's statement of people becoming artists. If there were more demand for artists, or more artists capable of increasing that demand, then we would have more artists (assuming of course we have sufficient wealth production to afford more artists.)

LMAO So you want me to refute a Republican talking point regurgitation?? Give me a break you wouldn't read it anyway but what we can take from our conversation is that we are in complete disagreement. I have a feeling your Republican talking points on the Affordable Care Act will be just that talking points sort like Trickle on Economics.

It is not you and I who are in disagreement, it is you and reality. I've even posted the links before. The ACA was NOT watered down by a need to court Republicans (none of whom voted for it) or less than foaming leftist Democrats; it was introduced in whole form, modified only by Vitter's amendment (which had near unanimous bipartisan support), and passed by bribing and/or arm-twisting Democrat Senators to get the necessary votes. In my opinion, it was the bribing and arm-twisting that got Scott Brown elected, far more so than the actual bill.

The bill's history is a matter of public record. I despair of making leftists understand and/or acknowledge it, like so much of reality, but I won't let you get away with flat out lying about it without being challenged.

 

[mattpegher]

There are also many changes that need to occur in the minds of Americans before we can have an efficent system.
1. There are guidelines regarding what kind of testing needs to be done or even can be done for any specific complaint. If you doctor says you dont need that test or medicine then you probably dont. Sure this is a discussion but if you dont trust the doctor to tell you whats best in his professional opinion, then find one that you do.
2. No body wants to be sick, but since the vast majority of illnesses are viral. Do not rush in to see your doctor the day you get sick. If severity warrant please seek attension, but rushing in to see you doctor the day your cold starts is premature. Your body needs to fight some infections, so if the symptoms are not grave try to wait a few days to a week. If the illness lasts greater than a week it is unlikely it is just a virus.
3. If I hear one more person tell me that "they are a ________ and cant afford to get sick" I think I'll lose it. People get sick, and no one's job is so important or individual that the world will suffer without you for a day or two. Sure you could lose some pay, but there is nothing I can do about that.
4. Next time your boss or your childs teacher tells you they need a note for your absence tell them to pay the damn bill for the visit. Millions of dollars are wasted annually due to "work/school note" visits. If you take too much time off work then fire your ass, if your kid is out of school chronically then send the truancy authorities on you.

 

[Ninjahedge]

How does competition, increase the price of healthcare?

Because healthcare is not competed on the price, but what they offer.

You always want the "best" no matter what the cost, you have insurance, right? So you go to a place that charges more, because they are "better", which makes the cost of insurance higher (with their additional margin tacked on) and everyones rates go up.

The biggest problem we have with health care is simple. Nobody wants to put a price on life.

We need to scale back our goals of "universal" and go for more of a basic health care system that will help prevent sickness, take care of a broken bone, or get your kid eyeglasses.

Cancer surgery, Emergency care and the like should be the things that "insurance" is for.

Keeping people healthy benefits both the people and the employers. Forcing insurance to protect you against an accident rather than paying for every oil change will make it a bit easier for people to afford what they are getting, reduce the size and complexity of the system, and let them weigh their OWN lives in what they are willing to pay for special/emergency care insurance.

All the crap I have been hearing from both sides will just not work, especially in a society that puts the price of life as infinite.

 

[mattpegher]

While I'm on a rant about waste of care. Every town in american needs a free clinic, staffed by a NP or PA to take care of the millions of unpaid and medicaid visits to the ER for Non-emergencies. I dont mind seeing the 3yr old with a severe ear infection and pain at 3 am but way to many people who have no intension of paying a cent are seen in ER's daily for stuff that could be seen in a clinic for 1/5th the price.

You would think that free clinics would be the logical place to start to establish a safety net for americans to recieve basic care. The reason that the government, both Rep and Dem dont want to do that is they would be responsible for cost, not just financing.

From an insiders point of view I can tell you the problem would be getting subspecialty referrals. We had a clinic at our hospital as well as a "charity care" for underpriveliged individuals but it was alway difficult to get them to the specialists.

 

[Ausm]

Agreed, there was intentionally a huge amount of stereotyping. But it's not far from Pelosi's statement of people becoming artists. If there were more demand for artists, or more artists capable of increasing that demand, then we would have more artists (assuming of course we have sufficient wealth production to afford more artists.)


It is not you and I who are in disagreement, it is you and reality. I've even posted the links before. The ACA was NOT watered down by a need to court Republicans (none of whom voted for it) or less than foaming leftist Democrats; it was introduced in whole form, modified only by Vitter's amendment (which had near unanimous bipartisan support), and passed by bribing and/or arm-twisting Democrat Senators to get the necessary votes. In my opinion, it was the bribing and arm-twisting that got Scott Brown elected, far more so than the actual bill.

The bill's history is a matter of public record. I despair of making leftists understand and/or acknowledge it, like so much of reality, but I won't let you get away with flat out lying about it without being challenged.

Flat out lying what am I lying about in your alternate reality?

 

[werepossum]

Flat out lying what am I lying about in your alternate reality?

That ACA was watered down to gain support from Republicans and Blue Dogs. Accept for Vitter's amendment, there were no changes made, period. The bill passed not by watering it down, but by arm-twisting and things like The Louisiana Purchase and the Cornhusker Kickback.

 

[hal2kilo]

Up until the Nixon Administration, the majority of the hospitals in this country were NON-PROFIT.

 

[Ausm]

That ACA was watered down to gain support from Republicans and Blue Dogs. Accept for Vitter's amendment, there were no changes made, period. The bill passed not by watering it down, but by arm-twisting and things like The Louisiana Purchase and the Cornhusker Kickback.

Ok but you probably won't read any of this but your're completely WRONG....

This is consistent with my own speculation as to why competitive bidding was stripped from health reform.

http://theincidentaleconomist.com/wordpress/why-was-competitive-bidding-stripped-from-health-reform/

When the Senate stripped these reforms from the final health care bill DeFazio successfully pushed it through the House on February 24, 2010 by a bi-partisan vote of 406 to 19.

http://www.defazio.house.gov/index.php?option=com_content&view=article&id=208&Itemid=20

http://www.healthleadersmedia.com/page-2/LED-274304/Hospital-MAs-Continue-Apace-in-2011##

Don't forget the Public option was stripped out too.

 

[jstern01]

How does competition, increase the price of healthcare?
Sure hospital systems compete for patients, and try to keep patients within their system for all kinds of services. However once a system is large enough to "build a new neonatal facility" they are already large enough to negotiate strongly with the insurance companies.

Large systems add facilities to capture market share but that doesnt increase the cost. If anything it increases competition and options for insurance companies to send patients elsewhere, decreasing the amount they are willing to pay for a service (the contracted rate).

This reminds me of the famous anti trust suit that the US started against GE and Westinghouse. They were colluding and rigging the price of gov't bids to decide who got which contract by the phase of the moon. I truly feel that both insurers and healthcare providers collude to milk the consumer. If it were true that having multiple hospitals in an area should lead to lower prices (ie competition), then medical costs should go down. But the simple fact that it does not matter if I go to hospital A or B the price is pretty much the same, indicates that either they are colluding or the fixed costs are the same (which I highly doubt, otherwise why would the second hospital been built).

Anecdotal evidence of this is when I went for my gallbladder surgery. It was not emergency surgery, but was necessary due to very large gallstones. My surgeon happens to have privileges at several local hospitals owned by different corporations, so I shopped around the price. The total cost difference on the surgery between them was about $200. Now on a $10K surgery that difference is 2%, tell me that is not collusion.