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What Happens When Doctors Only Take Cash (2017)

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Re: What Happens When Doctors Only Take Cash (2017)

#121

Post by Turing_Machine »

killjoywashere wrote: post #109
Turing_Machine wrote: post #102

Earlier quoted context omitted.

Every insurance company in the United States, along with Medicare and Medicaid, already has a fixed amount that they will pay the caregiver for administration of TPA. I guarantee it, even without bothering to look up what TPA is. If the procedure is covered by insurance at all , there's a pre-approved reimbursement amount for doing it. Outside of an expensive, time-consuming, and almost always useless appeals process…

I get that. Do you know the history of the CMS billing schedules? They called Dr. DeBakey and he sent a couple of his fellows to Washinton and they priced out every single thing. That has been revised, amended, and addended many times since, but yes, I'm well aware. The point is that there's no shopping around in the emergent cases. You can't say "Well, in my incapacitated, mid-stroke state, let me check the menu of…

"The point is that there's no shopping around in the emergent cases."

Why would "shopping around" matter if the amount the doctor was going to get paid was fixed (and published) in advance?

I don't understand why you think that pre-published fees would make this (alleged) problem worse rather than better.

In the (unlikely, IMO) scenario where one hospital really was massively more expensive than another, patients will almost certainly know that in advance, just as they know that they're going to pay more at Wolfgang Puck's restaurant than McDonalds.

Re: What Happens When Doctors Only Take Cash (2017)

#122

Post by serichsen »

From my german perspective, every assumption in this article looks quite gross and barbaric.

Here, everyone is insured. If you break your arm, you get it fixed. If you get cancer, you get therapy. If you get the flu, you get a prescription. The overall cost is paid by the entire population, through the insurance system.

For what is the alternative? Maybe the overall monetary cost would be lower if everyone had to watch the price, but you would pay for it in human lives and suffering, when people have to decide between dying of illness or dying of hunger, or between lifelong pain or clothes for their children.

Re: What Happens When Doctors Only Take Cash (2017)

#123

Post by lostlogin »

otakucode wrote: post #53

You son has broken his arm. The doctors in your town will only take cash. One of the doctors charges $50 to set the broken arm. The other doctor charges $500. Which one are you going to take your child to? Most likely, the $500 one. Because going to the bargain basement doctor is not something you do when dealing with medical issues if there is absolutely any way to afford it. It creates what I call 'reverse capitali…

> If your customers stop even being the ones footing the bill, it accelerates to a patently insane level.

The customers are the tax payers in many countries, and the bills there are much lower than in the US. Yes, those systems have problems, but this one is on a much smaller scale.

Re: What Happens When Doctors Only Take Cash (2017)

#124

Post by maxxxxx »

killjoywashere wrote: post #117
maxxxxx wrote: post #39

Earlier quoted context omitted.

When I hire a software developer or a lawyer I get an upfront price list. Would you hire a lawyer that either would not give you any price or told you "it costs between 2000 and 60000 depending on your insurance and some other factors we won't tell you"?

The difference is law, software, car repair, home remodels, etc, are all man-made systems. Medicine is dealing with a system that I think we can all agree man did not make.

A hospital is a very man made system and most tools they use are man made too. Most procedures are pretty standard too. There is no reason that they can't publish numbers other than that it's beneficial to them to keep them secret. Insurances have these numbers too but they don't want to publish them either. Everybody knows the pricing, the only participant being kept in the dark is the customer, aka patient who eventually has to pay.

Re: What Happens When Doctors Only Take Cash (2017)

#125

Post by nybble41 »

jimbokun wrote: post #89
mikestew wrote: post #72

Earlier quoted context omitted.

I'll let an ex-mechanic answer: me. In that situation the service writer (my go between me and the customer) calls the customer and tells them what is needed. If they don't want to do it, button it up and send them on their way. In your made-up example, there are fixes for a stripped drain plug that don't require dropping the oil pan. If it weren't for Jiffy Lube (who, more than once, stripped it before it got to me)…

But the heart surgery example is the exception. Many medical procedures and therapies have very predictable costs and outcomes. And have checkpoints to re-evaluate whether to proceed further. And accountants and could probably also price in the cost of the occasional problematic case and include a buffer in the standard price to account for it. There are plenty of straight forward ways to provide prices for the vast…

And for the cases where a decision is needed mid-surgery, the patient should have someone standing by to represent their interests and make those decisions on their behalf.

Re: What Happens When Doctors Only Take Cash (2017)

#126

Post by conanbatt »

paulmd wrote: post #106
conanbatt wrote: post #63

Earlier quoted context omitted.

Free healthcare is a great incentive for the state to ban alcohol, sugar and drugs. Not /s if you look at actual argumentation on soda taxes.

Ironically, the obese tend to have low overall healthcare spending. You die early and spare them the extreme levels of spending that typically occur during care of the elderly.

Time to do some sugar subsidies

Re: What Happens When Doctors Only Take Cash (2017)

#127

Post by tmnvix »

conanbatt wrote: post #114
verbatim wrote: post #110

Earlier quoted context omitted.

Your assumption that "someone else paid for it" only holds if the price was directly tied to external costs and not their own profit.

So you say investors pay for it? Very generous on their behalf.

If a client rejects my initial quote but accepts my lower one (for exactly the same service), did I also 'pay for it'?

Re: What Happens When Doctors Only Take Cash (2017)

#128

Post by tmnvix »

conanbatt wrote: post #99
wu-ikkyu wrote: post #65

Earlier quoted context omitted.

Pharmaceuticals

ding ding ding. These ones take most of the share. It is quite incredible that the U.S., the symbol of freedom, can't freely import drugs from abroad. Considering the rampant use of pharma specially, dropping the costs 1/2 of meds would lower the cost of healthcare overnight by an enormous amount.

Yep.

An interesting bit of data that highlights just how profitable this industry can be comes from the wikipedia page for McKesson Corporation[1]:

> On June 24, 2013, The Wall Street Journal reported that McKesson Chairman and CEO John Hammergren's pension benefits of $159 million had set a record for "the largest pension on file for a current executive of a public company, and almost certainly the largest ever in corporate America." A study in 2012 by GMI Ratings, which tracks executive pay, found that 60% of CEOs at S&P 500 companies have pensions, and their value averages $11.5 million.

[1] https://en.wikipedia.org/wiki/McKesson_Corporation

Re: What Happens When Doctors Only Take Cash (2017)

#129

Post by conanbatt »

tmnvix wrote: post #127
conanbatt wrote: post #114

Earlier quoted context omitted.

So you say investors pay for it? Very generous on their behalf.

If a client rejects my initial quote but accepts my lower one (for exactly the same service), did I also 'pay for it'?

If the other clients pay the higher quote, and thus it is a better strategy for you to put a higher price whichonly a few haggle, you didn't pay for it. The rest of the customers subsidize the haggler.

Re: What Happens When Doctors Only Take Cash (2017)

#130

Post by tmnvix »

expertentipp wrote: post #49

I've seen similar trends in post-Communist EU countries. We are importing the worst patterns from US. Public health insurance is most of the times miserable.

> Public health insurance is most of the times miserable.

I expect that your statement is about public health insurance in post-communist EU countries (I have no experience of this). Public health insurance in Australasia is very good (though has arguably been better in the past in some senses and could obviously be better in the future).

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