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A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

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Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#31

Post by kingkawn »

brightball wrote: post #29
kingkawn wrote: post #12

Earlier quoted context omitted.

Straight up exploitation of people during their most vulnerable moments.

It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people a…

Yes I also believe it is possible to spin a web of the intellect to make this seem like something else than what it is, but all you get from this is the satisfaction of a web well spun, and the exploitation continues.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#32

Post by brightball »

kingkawn wrote: post #31
brightball wrote: post #29

Earlier quoted context omitted.

It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people a…

Yes I also believe it is possible to spin a web of the intellect to make this seem like something else than what it is, but all you get from this is the satisfaction of a web well spun, and the exploitation continues.

It's what happens when you hide the price in a supply/demand chart.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#33

Post by distances »

dr_ wrote: post #27

The affordable care act has enrolled millions on to some kind of health insurance plan. Even if you are stuck with a high deductible plan, oftentimes that annual check up (preventive care) is fully covered without requiring a deductible payment. And, of course, if you are on Medicaid - you have Medicaid. If you are relatively young and/or healthy, that's all you would really need. As a result, their patient populatio…

Being from Europe, the concept of annual check ups sounds very wasteful. Is this what everyone does in the US?

As far as I see it, schools should teach enough to keep you in a good baseline health and doctors are available if something comes up. What is done in a normal annual check up?

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#34

Post by baldfat »

brightball wrote: post #29
kingkawn wrote: post #12

Earlier quoted context omitted.

Straight up exploitation of people during their most vulnerable moments.

It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people a…

It eventually is exploitation no matter how you slice it. Doctor's salaries and the money that is made in medical just because it is medical is insane. How much money does a doctor need to make? Why is $400,000+ a year okay when it is bankrupting thousands of people's lives?

> which happened from union demands

Explain????

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#35

Post by lr4444lr »

distances wrote: post #33
dr_ wrote: post #27

The affordable care act has enrolled millions on to some kind of health insurance plan. Even if you are stuck with a high deductible plan, oftentimes that annual check up (preventive care) is fully covered without requiring a deductible payment. And, of course, if you are on Medicaid - you have Medicaid. If you are relatively young and/or healthy, that's all you would really need. As a result, their patient populatio…

Being from Europe, the concept of annual check ups sounds very wasteful. Is this what everyone does in the US? As far as I see it, schools should teach enough to keep you in a good baseline health and doctors are available if something comes up. What is done in a normal annual check up?

They test for the symptoms of serious chronic health issues: blood pressure, urinalysis, blood sugar, cholesterol levels/ratios, joint reflexes, retina appearance, manual check for swollen tissues... things that might signal underlying conditions.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#36

Post by losvedir »

distances wrote: post #33
dr_ wrote: post #27

The affordable care act has enrolled millions on to some kind of health insurance plan. Even if you are stuck with a high deductible plan, oftentimes that annual check up (preventive care) is fully covered without requiring a deductible payment. And, of course, if you are on Medicaid - you have Medicaid. If you are relatively young and/or healthy, that's all you would really need. As a result, their patient populatio…

Being from Europe, the concept of annual check ups sounds very wasteful. Is this what everyone does in the US? As far as I see it, schools should teach enough to keep you in a good baseline health and doctors are available if something comes up. What is done in a normal annual check up?

Wow, I had no idea this wasn't a universal thing! Thanks for asking the question. From some brief Googling, it seems Canada also recommends against an annual health check, and I saw an article in NYTimes arguing against them, too. Fascinating.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#37

Post by brightball »

baldfat wrote: post #34
brightball wrote: post #29

Earlier quoted context omitted.

It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people a…

It eventually is exploitation no matter how you slice it. Doctor's salaries and the money that is made in medical just because it is medical is insane. How much money does a doctor need to make? Why is $400,000+ a year okay when it is bankrupting thousands of people's lives? > which happened from union demands Explain????

Well, doctors have to go to school for a very long time, especially to specialize. Then they go through residency programs. In all their general education before practicing on their own tends to be about 10 years more than the average American. Which is 10 years less income and 10 years more of expenses/loans. Most specialties cause doctors to be on call. Working in hospitals creates difficult hours.

And with all that we have a shortage of doctors in the US.

So, supply, demand, cost, working lifetime to make up those costs, hours, volume of paperwork to deal with insurance, even more for Medicaid, malpractice insurance and now the shift to EMR.

Doctors pay is the most justified thing in the medical industry. Until we have an excess supply of doctors that isn't going to change.

The other costs in medical are where the story really is.

> Explain????

Company provided health care became a standard thing from union demands years ago. Never allowing individuals to tax deduct insurance costs removed insurance from the consumer market, purchased for millions of people without any choice from the employees about who provides it and this became the primary mechanism for paying for health care.

Individuals are 2 steps removed from the costs of care, so what do they care if a hospital stay cost $30,000 if $29,000 is covered?

That's how your costs rise. Medical costs haven't been even remotely participating in the free market for decades.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#38

Post by crusso »

oldandtired wrote: post #9

A former travelling companion (on a long distance train trip) moved from Head of R&D for an advertising agency into working in the medical technology industry. After six months or so, he returned to his former job of head of R&D at the advertising agency. When quizzed by the staff at the advertising agency as to why he came back to such a corrupt industry. His comment was that advertising were little children in term…

factor of 10 over what they would sell the same product for to non-health care areas

That's a key statement.

So these same people charge less for the same product in other fields.

Why?

The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#39

Post by cookiecaper »

kingkawn wrote: post #31
brightball wrote: post #29

Earlier quoted context omitted.

It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people a…

Yes I also believe it is possible to spin a web of the intellect to make this seem like something else than what it is, but all you get from this is the satisfaction of a web well spun, and the exploitation continues.

It gets tiresome to see accusations of things like "mental gymnastics" and "web of intellect" every time someone attempts to discuss a non-trivial political issue. If we could just snap our fingers and fix all of our problems, we'd have done so by now.

Law, politics, and economics are hard, and they sometimes involve considering multiple factors. We shouldn't allow ourselves to be goaded into an unprincipled anti-intellectual stance by people trying to expedite their own solution.

Everyone agrees that the economics of health care in the US are bad. I don't know anyone who is happy with this state of affairs. Everyone feels like the other parties are out to screw them. Docs feel that they get fleeced by facilities and insurers, insurers feel that they get fleeced by beneficiaries and providers, etc. I had a medical device manufacturer as a client for a while and they too felt that the industry was unfair to them and that they had to set high prices to try to survive.

With so many people in the U.S. receiving their care on differing bases, it's hard to really get a single, strongly-motivated group to coalesce and push some real change through. Every employer negotiates their own contracts; some are good and some are bad, depending on how much your employer cares about benefits and such. Some people have state-provided care through Medicare or Medicaid. Others have to pay private (which is where things get really bad).

With everyone's experiences on such a deeply personal issue differing so widely, unification is difficult. Mix in a little political brou-ha-ha and it becomes nearly impossible. I'm sure that fracturing is part of the game by the insidious elements that lie underneath the covers, but it is a reality we must recognize and address legitimately.

On top of that, medicine is one of the largest industries in the U.S., and changes to that structure threaten to disrupt the employment of many people. There is no surer way to get a political position dismantled (and its elected purveyors destroyed in the next election cycle) than to threaten the livelihoods of a meaningful portion of the constituency.

Changes to the regulatory structures impacting all of this should be carefully considered, and I would hope that we at least run them through the "intellectual paces", as it were. Let's not jump on each other's backs with silly accusations for not acquiescing quickly enough.

Re: A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics

#40

Post by theparanoid »

baldfat wrote: post #34
brightball wrote: post #29

Earlier quoted context omitted.

It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people a…

It eventually is exploitation no matter how you slice it. Doctor's salaries and the money that is made in medical just because it is medical is insane. How much money does a doctor need to make? Why is $400,000+ a year okay when it is bankrupting thousands of people's lives? > which happened from union demands Explain????

The increase in medical costs is mostly not because of physicians, https://economix.blogs.nytimes.com/2008/11/14/do-doctors-sal...
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