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Why Medical Bills Are Killing Us (2013) [pdf]

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Re: Why Medical Bills Are Killing Us (2013) [pdf]

#71

Post by merpnderp »

no_protocol wrote: post #3

Why did the patient in the first story absolutely need to travel from Ohio to Texas for treatment? Isn't medical knowledge shared between providers? Some of the blame in many of these situations should fall upon the patients for choosing the care they did. Especially when it is a planned operation. I haven't finished reading the whole article, but so far it doesn't seem to be considering this point. I don't wish to d…

Someone I know was diagnosed with cancer. In Oklahoma they were prescribed a treatment plan. They went for a second opinion at MD Anderson. Anderson said that plan was dangerous and very well might lead to a bad outcome. The Oklahoma team said MD Anderson's plan would lead to a bad outcome. MD Anderson gets tougher cases and has the best overall outcomes of any hospital in the world so they went with them.

They're fine now and the standard of care at MD Anderson is mind blowing. At MD, a nurse comes in to draw blood and the whole routine is an organized set of steps. If one step changes, they throw away the kit, wash their hands and start over. In Oklahoma nurses just kind of did things however they wanted and gloves seemed more to protect them from the patients than to protect the patients from an accidental infection. There was just zero comparison in the overall standard at MD Anderson. Add in their outcome averages and the question becomes why wouldn't someone travel from Ohio to Texas.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#72

Post by ainiriand »

ainiriand wrote: post #65
ainiriand wrote: post #58

It is good to live in a country where I only spend 50 euro per month in taxes for all the care I could need! Its great to be in the first world!

The thing is, most people dont need to spend 50 euro per month so millions of people pay in order to not be left out the system if they need it. I need it when I was a kid, so now I pay gratefully.

In my opinion health welfare and security is a problem like the 'Three prisoners problem' where collaboration is better for everyone in the end.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#73

Post by Retric »

I think MRI's are a great example of the costs.

An MRI machine used on average 10 times a day for 10 years can do 36,500 scans at the cost of ~3 million for the machine. 3,000,000 / 36500 ~= 82$ for the machines time. (Clearly more if it's used less often, but also clearly not 500+$.)

This is a case where the actual cost has almost nothing to do with the machine it's all about manpower + some consumables. So, what's the manpower actually doing? A huge chunk of time in the US is simply billing aka waste.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#74

Post by FussyZeus »

yummyfajitas wrote: post #70
FussyZeus wrote: post #55

Speaking as an extremely pro-Capitalist person, this is the kind of area where Government interventions are required. Capitalism and fair markets require a few basic things: - Informed consumers (most consumers of healthcare either don't know enough about it to make any solid judgement) - Competition (most hospitals in any given area are grouped together and rarely compete, if at all) - Choice (if you're in an ambula…

As a person who consumes capitalist medicine in India, I don't see how any of your issues are fundamental to capitalist medicine. There is plenty of competition among hospitals. You can choose which one to go to (from an ambulance or any other time). Customers are strongly price sensitive and prone to comparison. There are plenty of choices as to where to go. Assuming I'm well enough to travel, I'll always fly to cap…

I can't comment on India's medical system, never used it and never really researched it. However:

> You can choose which one to go to (from an ambulance or any other time).

In theory, yes, in practice, it's a little harder. I mean if you were just in a car crash it's not a guaranteed thing that you're going to be capable of speech, let alone coherent enough to make your choice. And more importantly you shouldn't have to, your concern at that moment should be "put my head back together please" not "is this lifesaving treatment going to cost me my home."

> So do you believe that Indian doctors/other medical types are just vastly more ethical than the (very often Indian) doctors in the US?

This is not American doctors doing this (or at least, not the topic of this article): This is American businessmen who have no background in medicine that are making these decisions.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#75

Post by TheCoelacanth »

umutisik wrote: post #9
woofyman wrote: post #4

Earlier quoted context omitted.

I'm for single payer but it will never happen until Democrats get the White House and congress. Paul Ryan is planning on privatizing Medicare asap

The public option was removed from the eventual Affordable Care Act when it passed in 2010. The Democrats did have both houses of congress and the white house at the time, but that part of the law was brought down by a filibuster threat from a small group of 'blue dog' democrats. Had it passed, it would surely have been a trojan horse for universal coverage.

The public option had the support of all 59 Democrats. It was Lieberman, an Independent who often voted with the Democrats, who got the public option removed.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#76

Post by gbrs »

Retric wrote: post #73

I think MRI's are a great example of the costs. An MRI machine used on average 10 times a day for 10 years can do 36,500 scans at the cost of ~3 million for the machine. 3,000,000 / 36500 ~= 82$ for the machines time. (Clearly more if it's used less often, but also clearly not 500+$.) This is a case where the actual cost has almost nothing to do with the machine it's all about manpower + some consumables. So, what's…

Does that $3 million also include the expertise needed to operate and maintain the machine? You also need to account for the money the hospital needs to save to buy a new one when the one they have becomes outdated. Still might not add up to the actual cost they charge for a scan but it would look a bit more reasonable. My guess is the different negotiated rates for insurance plus the low income policies make everything convoluted and add a decent amount of overhead. I wish they would stop this negotiating crap and charge whatever it costs for them to do a scan. At least then I will know how much it will cost upfront.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#77

Post by distances »

james0001 wrote: post #62
mmel wrote: post #43

If anyone is interested, you can look up what single payer costs[1] are for various procedures in Australia, you can pay more than what is listed if you go private, but it still isn't anywhere near the cost of what procedures cost in the USA. [1] http://www.mbsonline.gov.au/internet/mbsonline/publishing.ns...

Can you get a private MRI without a doctor's requisition in Australia? I know in Canada they try to burn you at the stake if you do that.

Why would one get a private MRI without doctor's orders?

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#78

Post by cableshaft »

ceejayoz wrote: post #23
coredog64 wrote: post #19

Earlier quoted context omitted.

Preventative care that actually works is super cheap and not controversial (mostly vaccinations). This idea that we can save vast sums via preventative care is a fantasy. You may find anecdotes to support it, but the serious literature doesn't bear it out.

> Preventative care that actually works is super cheap The same's true about car maintenance, but plenty of people drive on dying brake pads and stretch oil changes anyways. A hundred bucks for a checkup is still more than many folks are willing to pay. As an example, here's a kid who died for want of a $80 dental procedure: http://www.washingtonpost.com/wp-dyn/content/article/2007/02... > not controversial (mostly v…

Well they usually want to do more expensive procedures along with the dental extraction. I've been delaying mine a bit because they want to take it out then put in a bridge, which will cost $1800 (normally $6700, but I have good dental insurance). In fact the extraction will be free, the cost is all in the bridge. But now you've got me paranoid again. Damn.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#79

Post by maxerickson »

gbrs wrote: post #76
Retric wrote: post #73

I think MRI's are a great example of the costs. An MRI machine used on average 10 times a day for 10 years can do 36,500 scans at the cost of ~3 million for the machine. 3,000,000 / 36500 ~= 82$ for the machines time. (Clearly more if it's used less often, but also clearly not 500+$.) This is a case where the actual cost has almost nothing to do with the machine it's all about manpower + some consumables. So, what's…

Does that $3 million also include the expertise needed to operate and maintain the machine? You also need to account for the money the hospital needs to save to buy a new one when the one they have becomes outdated. Still might not add up to the actual cost they charge for a scan but it would look a bit more reasonable. My guess is the different negotiated rates for insurance plus the low income policies make everyth…

It's perhaps more stark with the CT scanners mentioned in the article.

They pay off the capital cost in 1 year. If you figure they need two imaging technicians on site 24 hours a day, the labor to staff the machine is roughly 6 * $200,000, or $1.2 million per year. If they average 1 scan per hour (a scan can take as little as 5 minutes), the labor cost of those techs is $140 per scan.

If it costs more than $1 million dollars to service the machine per year (the machines cost less than that new), the service cost is $140 per scan.

Hospitals routinely charge $2000+ for CT scans.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#80

Post by yummyfajitas »

FussyZeus wrote: post #74
yummyfajitas wrote: post #70

Earlier quoted context omitted.

As a person who consumes capitalist medicine in India, I don't see how any of your issues are fundamental to capitalist medicine. There is plenty of competition among hospitals. You can choose which one to go to (from an ambulance or any other time). Customers are strongly price sensitive and prone to comparison. There are plenty of choices as to where to go. Assuming I'm well enough to travel, I'll always fly to cap…

I can't comment on India's medical system, never used it and never really researched it. However: > You can choose which one to go to (from an ambulance or any other time). In theory, yes, in practice, it's a little harder. I mean if you were just in a car crash it's not a guaranteed thing that you're going to be capable of speech, let alone coherent enough to make your choice. And more importantly you shouldn't have…

I mean if you were just in a car crash...

So in that case, lets have $YOUR_FAVORITE_SYSTEM for emergency medicine and capitalism for the rest. The vast majority of medicine consumed is not consumed in an emergency situation.

This is not American doctors doing this (or at least, not the topic of this article): This is American businessmen who have no background in medicine that are making these decisions.

So are Indian businessmen with no background in medicine more ethical?

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