"The Cost Conundrum" - great article about the rise of healthcare costs

[vi edit]

Very good article that gets right up to a point but fails to really address it. He says in there that "who pays won't make a difference". But that's only half true.

If we actually saw the bills up front, before we knew what we were getting, we either wouldn't do it, or wouldn't pay for it. Insurance (private or federal) has removed the transparency from the equation.

When I need to have work done on my car, the mechanic breaks it down by the procedure and tells me the bill up front. When it's done, I pay my bill and take my car home.

With insurance, I couldn't care less what is done. Just as long as they are doing *something*. I pay my $10 copay and walk out. The could have pulled 40 different labs, did 30 different xrays, a CT and an MRI on me...but my bill is still $10. I pay my bill and walk out.

I don't care what he bills for because it doesn't have any impact on me. Until there is some sort of fundamental shift and accountability (on both sides) then nothing will change...and that includes national healthcare as the article points out.

I work in health care supporting specialist groups (radiology). And what the article says is very true. If you go into an ED and have a CT/MRI/XR done, more than likely somebody there in the ED is going to do a read of that CT and make a clinical decision on that result. From there it goes on to some radiologist sitting at a $5,000 ergonomic desk, with $40,000 in high end monitors hooked up to a multimillion dollar PACS system just to look over that study and say "I agree" or "Don't agree". And that radiologist isn't even employed by the hospital. Meanwhile that patient is down in the ED having something done based on the initial interp by salaried staff physician.

 

[vi edit]

Originally posted by: ahurtt
The number one thing we can do to lower national healthcare costs is to stop being so god-damned altruistic and trying to save everybody. This is an excerpt from the article:

The logic in the article is faulty. Keeping more people out of the Dr.'s office to begin with by promoting healthy behaviors and healthy standards of living can in no way contribute to health care costs. How can a person who never needs any kind of medical attention other than routine medical checkups and physicals cause any extra burden on the health care system when compared with somebody who eats 5 big macs per day and is severely obese and smokes, drinks, and has multiple chronic heart and weight related conditions as a result? The general poor health of the population may not be the ONLY factor which contributes to the skyrocketing costs of health care in this country but it certainly is NOT helping AT ALL. I realize what the article said but I don't care. It didn't convince me.

He pretty much says it without saying it....specialists have screwed up the system. We need more primary care physicians. We need FAR FAR less specialists.

You can pretty much plot a trend in the explosion of healthcare costs with the rise in specialist practices.

 

[Mursilis]

Originally posted by: Phokus
Read page 7, it gives lots of examples where these incentives aren't skewed, but all the examples are because of not for profit care. Maybe for profit care should be outlawed somehow.

Interesting idea, but good luck getting it accepted here in the US. I can't really think of a system that will both address these spiral costs issues in an effect way yet will also survive the legislative process. The for-profit medical industry isn't just going to go away. Every day at lunch I watch CNN, and have to sit through those stupid commercials for the Scooter Store and the like. They promising the elderly motorized wheelchairs for little to no cost to you! We'll just bill Medicare on your behalf! To plenty of Americans, the Treasury is just something to be looted.

 

[Moonbeam]

Originally posted by: Mursilis

Originally posted by: Moonbeam

The problems of health care are a reflection of the big store in the mall, and that big store in our culture is the ME ME ME of capitalism.

Selfishness preceded capitalism, Moonie.

Of course. It is the root on which capitalism feeds. It is also a vortex that sucks everything in that direction, systematically.

 

[Moonbeam]

Originally posted by: Phokus

Originally posted by: dphantom

Originally posted by: Phokus

Originally posted by: dphantom

Originally posted by: Phokus
This is reassuring though:

Send those McAllen physicians to readucation camps or something. WTF. Greedy bastards.

The leftist answer to those who disagree or have a different view.

No, the issue is not so simple. For profit can work, but not where there is a de facto monopoly on care. The same problems exist in NFP too. So how do we change a behavior (McAllen) without rationing helathcare?

it was tongue in cheek you dummy

It really does seem that McAllen doctors are greedier

ok my apology.

And yes, the McAllen dr's certainly seem to be driven more by profit than care. Though I suspect this is true in many other places as well including some NFP's.

Read page 7, it gives lots of examples where these incentives aren't skewed, but all the examples are because of not for profit care. Maybe for profit care should be outlawed somehow.

The problem is systemic. You can't outlaw the profit motive. You have to change the system so that what is rewarded is care. And you have to pay people sufficiently so that worry about money isn't on their minds. We have to revive our humanity. Knowledge is power. This author of the article did a tremendous service because he brought an important issue into the light where the human conscience can think on it. The thing that changes behavior is the awakening of love, the realization that to live a life without it being ones light is to never have lived at all. You can't make people love. You can only demonstrate the benefits by loving yourself. It is why the King of the Universe has no army.

 

[Moonbeam]

a: The logic in the article is faulty. Keeping more people out of the Dr.'s office to begin with by promoting healthy behaviors and healthy standards of living can in no way contribute to health care costs. How can a person who never needs any kind of medical attention other than routine medical checkups and physicals cause any extra burden on the health care system when compared with somebody who eats 5 big macs per day and is severely obese and smokes, drinks, and has multiple chronic heart and weight related conditions as a result? The general poor health of the population may not be the ONLY factor which contributes to the skyrocketing costs of health care in this country but it certainly is NOT helping AT ALL. I realize what the article said but I don't care. It didn't convince me.

M: Of course it isn't helping anything but corporate America, with profit in mind, has made it impossible for huge portions of poor people to have nothing inexpensive to eat but food that is killing them. You aren't the only one who doesn't care. You are perhaps unconvinced because you don't want the matter to be more complicated than blaming the victims for being victims, but the data showed that poor overall health of the people there was not the driving factor in the excessive health care bill in that area given that areas with similar health demographics had much lower cost.

In short, you have a valid issue. It is not the one responsible for a difference in health care costs between different areas with the same levels of poor health. Such areas are a reality and need to be dealt with just as your issue does on some different level.

I do not think the problem of poor health lifestyles should be ignored and I don't think the issue brought out by the article should be ignored either.

The attitude of 'fuck um' is born out of frustration and despair, and too much of an eye on your own profitability. The people working on the issue will be much more emotionally happy with their lives than you will with the 'I don't care.' You might just care if you believed you counted for something which you do.

 

[TankGuys]

Originally posted by: dphantom

The leftist answer to those who disagree or have a different view.

No, the issue is not so simple. For profit can work, but not where there is a de facto monopoly on care. The same problems exist in NFP too. So how do we change a behavior (McAllen) without rationing helathcare?

I agree that it's not so simple. I don't think for profit can work when the people receiving the service aren't the ones directly paying for it.

I'd be willing to bet most of the people who get unneccesary procedures/tests are insured - they aren't going to risk racking up a huge bill for someone who may not pay it.

Patients with insurance often don't care what the cost is, since they aren't directly paying it. Yes, they do indirectly by higher premiums, but I would not be willing to assume that the "average" person makes this connection, or cares about it enough to really scrutinize the hospital bills.

So you have a system where the customers who have the highest capacity to pay high fees also don't tend to care how much they are charged. Thus, providers don't compete on price - they compete on how many amenities they can offer, which just drives up the cost more.

Not only do you lose the price competition that would theoretically keep a free market system in check, but the consumers of the service also stop making rational decisions, and stop putting in the effort to make "good" decisions that are also necessary to make a free market, for profit system work.


Obviously nationalize health care doesn't solve the above point - I'm just saying that in its current state, for-profit health care creates its own major issues.

 

[ebaycj]

Originally posted by: Moonbeam
The notion that the purpose of medicine is to make money is absurd. The notion of for profit hospitals is absurd. The limiting of the number of people who can be doctors by limiting the number of places in medical schools is evil.

100% agree.