The Glade 4.0

I'm not sure I agree that routine care shouldn't be included. My experience is that 99.9% of the populace won't do preventative care unless it's as part of some overall program, which means that you get people who don't address issues until it's a huge problem.

It's like a micro version of the no-healthcare/emergency room issue.

In the future, life will end at 30 with a ride on the carrousel. There will be no senior years and therefore, no goodies to be passed out.

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The U. S. Constitution doesn't guarantee happiness, only the pursuit of it. You have to catch up with it yourself. B. Franklin

"A mind needs books like a sword needs a whetstone." -- Tyrion Lannister, A Game of Thrones

Except the fact that it's expensive because insurance including routine care model. A great deal of the cost is the doctor's office dealing with billing overhead. They billed them $300 because it cost them a great deal just to submit the bill to insurance carrier.

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"It's real, grew up in trife life, the times of white lines
The hype vice, murderous nighttimes and knife fights invite crimes" - Nasir Jones

That's part of the problem. They won't go do their due diligence because they have to pay money but also because living a healthy lifestyle takes work and there is essentially no repercussions, financially. I look at the people I work with and most of the are fat slobs who subsist on terrible food and don't exercise to the point I can't even imagine how miserable they must feel physically

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"It's real, grew up in trife life, the times of white lines
The hype vice, murderous nighttimes and knife fights invite crimes" - Nasir Jones

Baby Boomers are the ones who voted themselves the best in the world on the backs of those who came after them - them and the "Greatest Generation".

Truth hurts sometimes.

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"...but there exists also in the human heart a depraved taste for equality, which impels the weak to attempt to lower the powerful to their own level and reduces men to prefer equality in slavery to inequality with freedom." - De Tocqueville

Here's the problem(s) with this statement: it shows your ignorance of both the healthcare system and economic drivers. Allow me to explain.

1) An otolaryngoloist is not "routine healthcare." That's a specialist. Specialists are, by definition, not routine.
2) Billed amount has literally nothing to do with the amount that things actually cost, or what the insurance company will actually pay, nor anything to do with your personal obligation.
3) Cost inflation in the healthcare market has occurred due to over-regulation and excessive liability.



Again, wrong, on all fronts.

1) MRI's do not cost that much, even hospital based ones.
2) The reaction you're describing would be negligence.
3) The physician would not detail costs of the diagnostic test to the patient.
4) Any physician who would react in this way (in addition to being negligent) would not retain patients for long, because other physicians would actually work to assist the patient in receiving the diagnostic procedures that they need.


I'm not sure what sort of negative experience you've had that colors everything you say about the American healthcare system, but you need to leave it at the door and stop attempting to talk as though you know how things work.

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“The duty of a patriot is to protect his country from its government.” - Thomas Paine

This. If folks took better care of themselves, they'd be perfectly healthy up until the point where they croak for no reason whatsoever.

^ Needs a sarcasm font ^

It's not. The biggest barrier to reliable preventative care is the current regulatory and entitlement systems in place. Government intrusion prices that average consumer out of baseline healthcare by artificially increasing the time and personnel required to provide that care. The cost multipliers on our current regulatory scheme and government rule-sets are exorbitant.

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I'm going to go with, "The government doesn't pay for it," for $500, Alex.

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Buckle your pants or they might fall down.

And here I thought Xequecal had just seen one too many episodes of Chicago Hope.

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Can you guys provide some numbers and examples backing those statements?

As of 2008, there 670,000 licensed doctors in the United States. That's one doctor for every 470 citizens in this country. Even assuming perfect distribution of labor, knowledge, and resources, and no overhead, they would need 3 support staff each to run a general practice that saw 8-12 patients a day.

If they accept insurance or Medicaid/Medicare money, that number of support staff required triples, per physician.

That's all you really need to know.

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Sure, if you can provide me with a crystal ball to show you a parallel universe in which the over-regulation and liability didn't come into being.

Sarcasm aside, you're asking me to essentially distill 7 years of industry experience combined with a 3 year graduate program into one easy-understandable post. So the answer is, at it's most basic, "No, I cannot provide you numbers and examples."

What I can tell you is that it's simple economics: regulation drives compliance measures. Compliance measures require resources (people, infrastructure, or otherwise), which add cost. Liability drives over-treatment. Over-treatment increases cost.

The only other major driver of healthcare inflation is technology, but personally I don't find that a negative so I never include it in discussions of healthcare inflation. This is because I assume that you'd rather have an MRI, CT, or whathaveyou to diagnose a problem than a 1960's era X-ray.

Minor cost inflation items that aren't significant, but do exist, are uninsured patients and standard business inflationary factors (cost of goods, real estate, taxes, etc.).

The simplest and most concrete example I can demonstrate for you is this: if you were to be admitted to a hospital for care under private insurance, you fill out 1-3 forms, depending on how efficient the hospital system is (meaning that industry leading practice is to consolidate the forms). 2 of those 3 forms are purely for regulatory and liability purposes: 1) consent to treat you (liability), 2) acknowledgement of HIPAA rights (regulatory), 3) consent to pay (business-driven). These forms must be acquired, sorted, stored, and monitored by human capital, which costs money. Compliance with acquisition of these forms must be furthered monitored, which requires additional human capital, which costs money.

If you were a Medicare patient, I'm going to add 2-3 forms to this list, all driven by compliance, and for literally no reason except that you have Medicare. 1) acknowledgement of Medicare patient rights, 2) Medicare observation letter, and possibly 3) Medicare Advanced Beneficiary Notice (if your admission does not meet guidelines created by Medicare simply to deny payment for services based upon alleged "medical necessity" criteria). I should point out that these forms cannot be combined, thus requiring more intense time requirements to monitor compliance.

I should also point out that all of this is technically before care can even commence, must less throughout your stay and post-discharge needs. The latter paragraph, specific to Medicare patients, also will net the hospital less money (in addition to costing more) because Medicare doesn't pay as much as private insurance does.

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“The duty of a patriot is to protect his country from its government.” - Thomas Paine

It’s not just healthcare, it’s also the tests related to basic healthcare. A generic example of a blood test for a certain thing… lets say cholesterol.

Before being approved for use, this test must undergo.

Design
Validation and verification of design
Clinical validation and verification
Clinical utility (whether there is a place for a new product of this type on the market)
Clinical expert’s report
Supplier assessment (each raw material, manufacturing and release suppliers)
Submission of product to the regulator body (FDA) for assessment and do further studies if requested.
Manufacturing of product and keeping the first 3 batches for stability testing
Clinical assessment of the product in real world settings

Not saying all that is not needed, but all that is cost added to each test you do. Keeping in mind, most test comes in 100 boxes that can not be separated, so if you’re testing for a rare disease where only 10 other people in the country has, you’ll most likely be paying for the whole box of reagents.

That being said, knowing a result from a preventive test is still better than going through with the consequences, which in this example is a stint (heart surgery, not fun). Unfortunately “reliable preventative care” depends on the determination and regulation of self, and we all know how well that works in the general public.

Anecdotally I can...

I have a dog diagnosed with fungal meningitis last April. We ended up taking him to the vet college at Mizzou where he stayed for several weeks and got cat scans, mri's, spinal fluid evaluations, etc. He took prednisone regularly (until just a couple of weeks ago) and monthly chemo therapy using cytosar - the combined cost of the medicine, the several days stay at the vets and the follow up blood tests are just over $400.00 each treatment.

All this was done using the same equipment, treatment, and medication used by humans. No insurance, of course. I've paid a total of around $4,000.00 to date to treat this dog.

I'm thinking regulation and government rules are pretty much the difference between that and what I can only imagine the costs would be for an uninsured human with the same diagnosis.

Oh, and the dog is doing great! No visible signs he was ever ill.

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In time, this too shall pass.

Happy to hear your dog is doing well Taskiss. I can only imagine what that would cost a human, even with insurance, especially if that human is on Medicare. Can't wait to find out what that will cost.

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"Said I never had much use for one, never said I didn't know how to use one!"~ Matthew Quigley

"nothing like a little meow in bed at night" ~ Bruskey

"I gotta float my stick same as you" Hondo Lane

"Fill your hand you son of a *****!"

For reference, it is entirely possible for any individual to determine what any hospital will get paid by Medicare for a standard payment for any given inpatient episode. So if, for example, Taskiss' dog was human, on Medicare, and admitted to a hospital for fungal meningitis, there would be a Medicare Diagnosis Related Group (DRG) for that care. The equation is pretty complex but you can find everything necessary to determine payment to the hospital online through public, free sources.

Standard Medicare typically then has a 20% co-insurance for which the individual would be responsible (sometimes with a deductible). I invite anybody interested to investigate the payment for Fungal Meningitis (ICD-9 code 321.0). Currently, as far as I can tell, this would fall under DRG 561.

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“The duty of a patriot is to protect his country from its government.” - Thomas Paine

What I find interesting is, the $4,000.00 I've paid isn't the cost of treatment, it's the cost of treatment and also includes the corporate profits necessary to keep an animal care clinic and a college training hospital running.

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In time, this too shall pass.

part of it is also malpractice insurance too. Last I checked my mother was paying something like 1/3rd or 1/2 of her salary just to cover he own malpractice insurance.

I find it interesting that you mention this, because in my opinion everything about the way insurance and healthcare currently works in the US gives the patient the impression that he is being defrauded at every step. While I know insurance companies aren't the cause of the costs, as they have very slim profit margins, from the paperwork you get and the experience you have when you go for care, it certainly SEEMS like you're getting screwed by both the insurance company and the doctor's office.

For example, I recently went to the dentist for a routine cleaning and a filling. After this visit, the first document I get in the mail is a statement from the insurance company. First, it lists a procedure code and short description of everything the dentist did. I usually can't understand the description, as it's hardcore medical jargon and every second word is abbreviated. Sometimes I can make some of them out, but I'm fairly sure most people don't consistently understand these descriptions. Next, for each procedure, it lists a billed amount and a repriced amount. I assume the billed amount is what the doctor billed to the insurance company, and the repriced amount is what the insurance company actually decided they were going to pay the doctor. The repriced amount is usually a tiny fraction of the billed amount, sometimes less than 5% of it. Then finally, it lists insureds' liability, which is the difference between the two columns.

So, the first thing most patients do when they get this statement is panic, because they just went in for 1 filling and a cleaning, and despite having insurance, this statement says they owe some ridiculous amount of money like $1,718.21. Of course, the next statement I get comes from the actual dentist, and of course he doesn't bill me anywhere near what is listed as the "insureds' liability" for each procedure on the other statement. However, the bill from the dentist also lists what he received from the insurance company for each procedure. Interestingly, these numbers NEVER match the "repriced amount" numbers on the insurance company's statement. I always check. They're never even close.

Next, I have 50% coverage on my dental plan for stuff like fillings. But when I look at these bills, I wonder.....50% of what? I certainly didn't get 50% of the billed amount. I didn't get 50% of the doctor's own charges for each procedure. How do they even determine what I'm getting 50% of? It certainly can't be the exorbitantly high billed amounts. Is it supposed to be 50% of what the doctor charges me in his own bill? How does the insurance company even know what he charges me? Do they actually have some idiotic agreement where he bills them some stupidly high number despite them knowing what he actually charges patients? It is utterly and totally incomprehensible as to how the insurance company determines what amount it is going to pay me.

Then, of course, come the exceptions. You needed two shots of lidocaine to get fully numb, but the insurance only covers one shot, so you have to pay for that. And you got xrays 18 months ago, but we only allow them every two years, so you have to pay for that too. Every time there's always a bunch of excuses for why they're not paying that probably are spelled out in your policy, but no sane person could ever be expected to reasonably remember all of them whenever they go to the doctor. All they know is, when they go, there's a significant portion the insurance is going to refuse to pay for, just because they can. One time, I did a search on my insurance company's website for a doctor. It referred me to a Dr. X and gave me contact information. I called the number and made an appointment with Dr. X. I went to the address on the insurance company website. I saw Dr. X. Afterward, the insurance company refused to pay me because the doctor I had seen was actually Dr. X's son, also of course named Dr. X, who was working out of the same office.

Everyone I know who has insurance has stories like this. I went in, I thought I did everything right, but they found some bullshit excuse not to pay.

Now, here comes the worst part. I figured, hey, a lot of people probably have my insurance plan, I'll ask the doctor's office what I can expect to pay, BEFORE I have anything done. The thing is, the doctor's office DOESN'T KNOW what I'll end up paying. They claim they don't know what the insurance company will and will not pay for. NOBODY seems to know. My best option here seems to be making a ritual sacrifice to the whimsical God of Medical Billing.

Oh yeah, and when I asked about costs? The secretary first thought I was asking about what it would cost if I was just paying for it myself, sans insurance. And they DO have a price sheet for that. And the prices are about 30-40% cheaper than the prices given to me on my bill. So not only does it look like I was defrauded at every step, but even the entire act of purchasing insurance was itself an exercise in fraud. I've apparently been paying a monthly premium in exchange for two cleanings a year and a 10% discount on everything else, because they give people without insurance 40% off, while my insurance only covers 50%.

Xequecal:

Do you even pay attention to the political rhetoric coming out of the White House? You do know that the AD Council and Department of Health and Human Services have been running broadcast radio ads for the last 24 months explaining how all of America's healthcare problems stem from greedy private practices, right? That Obamacare is necessary to control rampant profiteering and fraud in the medical industry?

Has it never occurred to you that the easiest way to migrate the United States to a single-payer system is to FAIL at a decentralized National Healthcare Policy?

Hell, I'll bet you've never even heard the campaigns that resulted from Michelle's anti-obesity agenda either; they're appalling. Our government is literally using tax dollars to instruct parents into lying to their children.

Also, no, they don't have discounted rates for full cash payments at the time of service anymore. Obama's Administration and Pelosi's House made sure that part of Obamacare went into effect immediately. You can't say healthcare is broken if people know they can pay actual value for the services if they avoid all the bureaucracy you seem to think we need more of. Federal Law also says insurance cannot reimburse more for a procedure than Medicaid/Medicare allows now, either. And since insurance companies pay the lowest accepted rate, there's where you price fixing comes in.

EVERYTHING wrong with the current state of U.S. Healthcare lays at the feet of our government. You can't ask government to fix something it so colossally broke, especially not when it being broken benefits the government.

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Xeq:

Couple things, meant without disparagement.

1) Insurance company profits are actually quite solid. It's providers that usually have ultra slim margins.

2) Complexity is not the same as fraud. Failure to understand a bill is not the same as fraudulent intent.

3) The complexity is a serious barrier to patient experience. Everybody with serious experience in healthcare knows this.

5) This complexity is one of the major reasons care costs so much.

6) This complexity is driven by regulation and 40+ years of Medicare history.


I'm happy to give a primer on these things, if I ever had time.

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“The duty of a patriot is to protect his country from its government.” - Thomas Paine