511–520 of 1001 posts
What about quality of care tradeoffs? In Canada, for example, you are forced to use the government system, and if it doesn't deem you important enough, there is no private option.
Same here in the UK. If you need to see a specialist, you regularly have to wait months, assuming you can even get a referral in the first place.
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> Hospitals have an operating margin of 2-5% Very curious where this comes from and how accurate it is. For example the $37 a provider charges for an Aspirin seems like more than 2-5% margin.
Hospital billing practices are often terrible or even fraudulent, but stories about the $37 aspirin are generally misleading. Most hospital claims and bills are actually coded around day rates and DRGs, so even if the aspirin shows up as a line item it doesn't actually impact the patient's financial responsibility or the amount allowed by their health plan. (I'm not trying to defend such a confusing system, just expl…
Yep. Hospital "bills" are a fiction. On one occasion I was presented with an "Explanation of Benefits" for a hospital stay where I was "charged" for being in two hospital rooms at the same time. As if that weren't enough I was also "charged" with having a "Pap smear"[0], even though I don't have a cervix.
I complained bitterly and after making a big stink was informed by the hospital my insurer that the items weren't actually "billed". Rather, the insurance company paid $1500/day regardless of the treatment provided.
It's disgusting!
This is the harsh reality. No system (private or public) can save all of the lives.
We are debating who will make the decision of who gets to get a chance to live longer.
I'd like to believe this, but the study makes a bunch of really hasty assumptions. The authors derive the $1T number from $1.3T in total cost savings and $304B in incremental spend (incremental spend is due to insuring more people). The $1.3T in cost savings come from five big buckets: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewe…
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Physician/nurse salary is not the major driver of the cost of healthcare. It's around 12-15% spending, depending on the methodology. Even if you force doctors to work for free, it won't meaningfully affect the cost. It's really the overhead costs that are so Byzantine that they can't be quantified properly. Hospitals have teams of coders, insurance companies have teams of counter-coders, physicians have to waste thei…
https://nationalhealthspending.org/ BIR is 8.5% of provider spending, once you add the multiple cells up that constitute providers. I don't think your argument is going to survive contact with the numbers here.
I have a bit of personal experience here. I had a partner working as an endocrinologist, one of the higher-compensated medical professions. They were spending at least 1 _hour_ every day on calls with the insurance companies for prior authorization instead of seeing patients.
Some things are also weirdly broken down:
> Net Cost of Health Insurance Expenditures - 6.2% > Administration and Net Cost of Health Insurance - 7.4%
Why are they split?
I also suspect that they included some admin personnel cost in the physician/nurse salary. For my partner, their office employed a person just to deal with insurance. There is no easy way to break down these costs for small practices.
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https://nationalhealthspending.org/ BIR is 8.5% of provider spending, once you add the multiple cells up that constitute providers. I don't think your argument is going to survive contact with the numbers here.
I just don't believe that it's correct. The Kraken hides here: Hospital Expenditures - 31.2% I have a bit of personal experience here. I had a partner working as an endocrinologist, one of the higher-compensated medical professions. They were spending at least 1 _hour_ every day on calls with the insurance companies for prior authorization instead of seeing patients. Some things are also weirdly broken down: > Net Co…
And they're not split: one row is an aggregate of subsequent rows, as you can see by simply adding them up.
This is just a colorized table view of a spreadsheet Medicare publishes every year.
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Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency > The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost. > In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.
We want consumers to consider cost when evaluating what services to buy, though. That's a feature. The medical emergency debt statistic is just the usual thing of people not really understanding how medical insurance works.
There have been studies like this for decades, going back to at least the Clinton administration. And nothing will come of it. Too many entrenched interests, regulatory capture, and lobbying + political donations.
If spending drops by $1t, it will come out of someone's paycheck. Yes, some are greedy folks who will be just fine making 20% less a year. But many will be nurses or hospitals or some combination of providers.
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One can always craft some excuse, which is how the terrible system continues to perpetuate itself. Doctors cannot even tell you how much they themselves will charge for anything . The problem I'm describing originates completely with them - no escaping blame here. (And " might take years " lol. How about eliminate whatever flagrant regulatory capture is allowing providers to create and enforce post-facto and downrigh…
Feel free to blame doctors if that makes you feel better but the reality is that in most cases they literally have no way to accurately calculate a patient's out-of-pocket cost in advance. Like there's just no technical way to do it. If you have specific suggestions for fixing the regulatory capture problem then you can submit a petition for rule making under the Administrative Procedures Act. https://www.govinfo.gov…
I don't know the specific legal details that allow doctors to make up these post-facto bills (often fraudulent) and send them to patients, but I feel it's probably at the state level rather than federal. Also the big problem with regulatory capture is that businesses paying off politicians makes that kind of citizen feedback meaningless.
[0] in fact I think another good angle of reform would be "if a patient has a health plan, providers are prohibited from billing the patient directly". Any copays, outstanding balances, etc should flow through the health plan.
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Exactly this. They need to offset the areas where they lose money. And we have federal laws (justifiably so, IMHO) that ERs must provide stabilizing services regardless of insurance and ability to pay. And while that law is obviously humane and reasonable, my only gripe is that the rest of our system is so backwards that it increasingly forces people to leverage that. There was a story about a woman who needed dialys…
But wouldn't nationalized healthcare help with this? The amount of uninsured individuals would drop drastically.