131–140 of 276 posts
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This is an interesting film to learn more about the healthcare industry in the US. http://www.imdb.com/title/tt0386032/
Please don't ever suggest a Michael Moore production as suitable for increasing one's knowledge on a subject. At best the man is an entertainer, nothing more. His works have about as much claim to the title "documentary" as does reality tv.
The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…
Actually, it is not just the healthcare industry. All industries in capitalist societies are engineered with greed in mind, and that's OK. It works very well. The problem in the healthcare industry is not greed, but insurance. When someone else is paying for the care you don't care how much it costs. You don't shop around. This enables doctors and hospitals to charge more. American healthcare is very cost efficient where the care is not covered by insurance, for example plastic surgery, lasik etc.
The article used the Diagnosis Related Group (DRG) 238 - Major Cardiovascular Procedures without Major Complications. This is the best guess at capturing the costs of "Open Heart Surgery". (CMS only releases data for the top 100 DRG codes). "Open Heart Surgery" is a term for a variety of surgical procedures done on the heart, including valve replacement, vascular repairs of the aorta/vena cava/pulmonary vessels, and coronary bypass. These span a wide variety of DRG codes, including 216-221 for valve replacement, 228 (other cardiothoracic procedures with major complications), and 231-236 for cardiac bypass. Assuming we are comparing the operation known as coronary bypass grafting, then 238 is a decent enough code to use, with the proviso that it's not the best source for data.
Looking at the numbers claimed: If you download the Excel file from CMS [1], you can sort by DRG and Provider Name. Yes, if you search by DRG 238 and filter by Cleveland Clinic you will get $106,385 charged to Medicare. However, what the article completely leaves out (and anyone in medical practice will assume) is that Medicare simply does not pay the amount covered. Average Total Payments by Medicare: $26,898. That's how much Cleveland Clinic gets reimbursed, on average, by Medicare for any procedure included in DRG 238.
It gets more interesting when you include all providers and sort by average total payments. The highest average Medicare reimbursement to anyone for DRG 238 is $54,682; the lowest $13,233. Another interesting example:
In Alabama, at Brookwood Medical Center, DRG 238 covers $111,008 and only reimburses $15,552.
These comparisons of the US system to outside countries really need to compare average US reimbursement to their stated cost, because they sure aren't funding an army of administrators to get the insurance companies to pay up.
In summary, you can get "open heart surgery" in the US (Alabama) for "$15,552". I wonder what the Alabama price is if you walk in and offer to pay cash. If you can get it at the Medicare reimbursement rate, that compares decently to the Indian price.
[1] http://www.cms.gov/Research-Statistics-Data-and-Systems/Stat...
The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…
"You don't see this kind of innovation in the American health system because it has been engineered with greed in mind right from the start." Actually, it is not just the healthcare industry. All industries in capitalist societies are engineered with greed in mind, and that's OK. It works very well. The problem in the healthcare industry is not greed, but insurance. When someone else is paying for the care you don't…
Can't resist posting this anecdote from Atul Gawande's (best known for his New Yorker medical pieces, such as the one about checklists) book, Better: A Surgeon's Notes on Performance...at the end, he describes spending some time in India as a visiting surgeon to see how innovation was possible in comparatively squalid circumstances. The Nanded hospital he describes below serves 1,400 villages, about 2.3 million peopl…
What is the survival rate in India after that procedure, comparing to the US? My colleague _visited_ India and returned with a stomach flu, spent a week in a hospital.
So because your friend ate some bad food, that country's hospitals must be unhygenic? Yup, I totally see the correlation there. I'm Australian, visited the US and got severe Salmonella poisoning in Vegas... the US must have really shocking road safety laws.
So yes, the low mortality rate after surgeries is actually a surprise for me.
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>>You don't see this kind of innovation in the American health system because it has been engineered with greed in mind right from the start. As an Indian, I can tell you people here think the same about our health care system. The Doctor in discussion here, Dr Devi Shetty is a sort of a local hero here in Bangalore. And who knows in some years he might as well be a national hero. Its basically because he seems to br…
> You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. I find the vast majority of people are tripped up by currency conversion, but I'm surprised to find this on HN. In Japan $1 = 100 yen, but certainly I don't feel I have 100x in buying power. A bowl of ramen will cost me $8 in SF; an equivalent bowl will cost me 800 JPY in tokyo. L…
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"If the difference between the exchange rate between two countries doesn't change for a long time the prices of goods in both countries end up being roughly the same." Simply not true. Compare the cost of a beer in, say, Thailand and Norway. Are you suggesting if the exchange rate were fixed they would reach parity over time?
Assuming no new disruptions, then yes, economic conditions in the two countries would eventually equalize and prices would differ by at most the shipping cost if one of the two countries happens to have much better natural conditions for producing beer than the other. It's because disruptions are now becoming (have become?) the norm that equilibrium never has time to come close to manifesting itself.
The Big Mac index is better for many reasons, one being Mcdonalds is large enough to mostly optimize everything wherever they operate:
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A huge problem in the US is all sorts of really really bad laws. For instance to open a new hospital you have to get permission from other hospitals in the area.
> For instance to open a new hospital you have to get permission from other hospitals in the area. This sounds like a terrible law. Where can I look for more information on this?
That excess capacity tends to be filled up with old and poor people on government health programs, and people needlessly hospitalized are likely to get more sick as a direct result of their unnecessary hospitalizations.
Medical tourism has hurt most Indians. 1583 USD is almost 100k INR. The average per capita income in India is 1219 USD (72k INR). This figure too is very misleading, since poverty is a huge problem. A very simple plotting with data from wikipedia and rudimentary extrapolation, shows that more than 1.1 billion Indian's annual income is less than the current cost of heart surgery. India's total population is 1.2 billio…