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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)

#151

Post by rosege »

maxxxxx wrote: post #76
sethammons wrote: post #32

Earlier quoted context omitted.

Heh. I have tried to call to see the cost. I see a retina specialist twice a year. I recently changed to a high deductible plan with an HSA. I called to see what the cost of my appointment would be. They could not or would not tell me. Incall three separate times, talking to different people and different departments. I went in and continued asking the front desk. "It depends on the services you end up getting." Ok,…

The same happened to me when I had an HSA. Estimated price for a procedure was first $4000, then $2000, then $100. Eventually paid $500. they just seem to make up prices.

from my limited experience with health care in the US, it seems more like a 3rd world bazaar where you haggle over it.

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

#152

Post by killjoywashere »

Turing_Machine wrote: post #121
killjoywashere wrote: post #109

Earlier quoted context omitted.

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 wil…

The rates generally are published, via CMS. This whole thing is barking up the wrong tree. The rates are one thing. Coding is the real art. Making sure you captured every RVU, CPT code (do you have any idea how many arterial lines might be started on a patient dying of diffuse intravascular coagulopathy?) How do you capture all that?

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

#153

Post by Pokepokalypse »

conanbatt wrote: post #107
rocketpastsix wrote: post #104

Earlier quoted context omitted.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

> ate the cost. If they ate the cost, someone else paid for it. Which means that prices in general take this into account. I'm not judging OP, but saying that the ability to apply that technique is not= the solution to the general problem. (Healthcare is expensive).

Yes, they are fucking over someone else, by padding their bill, and hoping their insurance pays for it - which is why most of us are paying $2000+ /month, if we have an employer-provided plan. (keeps the real costs concealed from the people who are paying).

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

#154

Post by ams6110 »

bawana wrote: post #143
conanbatt wrote: post #62

Earlier quoted context omitted.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

bertolini walked away with 500 million when cvs bought aetna. those were health care dollars paid by working people as premiums

A drop in the bucket. Insurance executive compensation is not the problem.

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

#155

Post by chrismcb »

conanbatt wrote: post #107
rocketpastsix wrote: post #104

Earlier quoted context omitted.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

> ate the cost. If they ate the cost, someone else paid for it. Which means that prices in general take this into account. I'm not judging OP, but saying that the ability to apply that technique is not= the solution to the general problem. (Healthcare is expensive).

Sure. But not exactly. No more than you paid extra when the bus boy dropped a load of dishes and broke them. In this case a mistake was made, and the business are the cost. It might have meant prices went up the following year, but I doubt it, as that wasn't really that much money.

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

#156

Post by berbec »

qubex wrote: post #43
Giacomot wrote: post #29

Earlier quoted context omitted.

Free healthcare is a great incentive to be careless with your body. /s* edit: I was being sarcastic

I see you're being voted down but you might actually be right... if I feared that kind of monetary consequence I'd never walk out the door.

I walk around fully aware I am one slip and fall away from inescapable, permanent financial ruin. I have insurance, but my $8,000 deductible means if I break my leg falling down a flight of stairs, I'll be in bankruptcy court once the cast comes off.

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

#157

Post by Pokepokalypse »

mcny wrote: post #50
IncRnd wrote: post #38

Earlier quoted context omitted.

The problem really isn't the doctors but the structure of insurance and how people treat health care and health insurance similarly. The worst part is that high costs aren't directly the fault of insurance companies but of government having driven the need for insurance. Health care used to be all cash, and people carried catastrophic health insurance policies only. We are moving back towards that. This isn't stating…

> The problem really isn't the doctors but the structure of insurance and how people treat health care and health insurance similarly. The worst part is that high costs aren't directly the fault of insurance companies but of government having driven the need for insurance. Health care used to be all cash, and people carried catastrophic health insurance policies only. We are moving back towards that. This isn't stati…

Okay, so on the catastrophic-only front: what about chronic issues, like diabetes, or depression, etc? Insurance pays for the initial crisis - but ongoing treatment comes solely out-of-pocket?

Nobody can afford that. Especially with how drug prices have escalated. And in some of these chronic conditions, the end-stages become very costly.

Insurance absorbs the early costs of regular care, which PREVENTS both chronic conditions, and these costly end-stages. (This is widely-accepted science, not insurance company marketing).

So this catastrophic-only model simply is not tenable, will not work. Unless either these treatment prices come way, way, down. OR: we address the real source of the problem, which is that incomes have not come up to meet these niche costs which have inflated greatly, yet somehow avoided being measured and added to overall inflation statistics. ("hedonic adjustments", anyone?)

Trump actually campaigned on lowering drug prices. Yet for all we've sacrificed to endure a Trump presidency, they've done absolutely nothing to address this problem. And they won't. I assure you.

Therefore - the shitty-compromise solution must be: government pays. Because they're too cowardly to fix the problem any other way. Government pays until government can't. So they just borrow more. Not even "plain speaking" Trump has the balls to work these two problems. (Drug prices, and income stasis).

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

#158

Post by Pokepokalypse »

thephyber wrote: post #73
topspin wrote: post #68

Earlier quoted context omitted.

I've studied this a little. There are many stories depending on what you choose to believe. I believe the current state of affairs is a consequence of tax policy; health insurance benefits are untaxed income, a tax policy often attributed to powerful labor unions in the early 20th century. ACA attempted to tax "Cadillac" plans but the sunrise on that was kicked years down the road and when it was about to take effect…

> is a consequence of tax policy; health insurance benefits are untaxed income, a tax policy often attributed to powerful unions in the early 20th century. I can't remember where I heard it, but IIRC employer-sponsored health benefits had to do with a fringe benefit that employers could give to attract employees during a national wage freeze (perhaps WW2). I just found this timeline[1] that confirms my broken memory…

yes

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

#159

Post by Pokepokalypse »

conanbatt wrote: post #62
harrisreynolds wrote: post #46

I've been wondering for a while now why health insurance companies exist at all. They introduce a massive bureaucracy and massive costs and provide very little value. They evolved from a reasonable idea into a monster that just drains our system and do not provide enough value to justify their existence in my opinion.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

healthcare monopolies (hospital chains, lab chains; where nationally there is competition, but in local areas, particularly rural they are effectively a monopoly).

They charge whatever the fuck they want.

Also; equipment manufacturers and drug companies: who both abuse the shit out of our patent system. But even off-patent drugs are being priced ridiculously high now. Barriers to competition are still extremely high.

Since manufacturing capacity of IV bags was taken out in PR, there is a national shortage. This is NOW causing rationing (in effect). Prices are going up, but nobody's addressing the manufacturing problem - because: Puerto Rico.

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

#160

Post by Pokepokalypse »

tmnvix wrote: post #128
conanbatt wrote: post #99

Earlier quoted context omitted.

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 c…

yes, and before anyone says: "but muh R&D funding!" -- these companies generally have marketing budgets that are 2-3 times the R&D budget. (plus, most basic research is public or university funded). "but muh FDA certification costs" - - there are huge tax carve-outs for these. It's not a main driver.

And no: marketing is not necessary for these products. TV commercials and other ads to public: not necessary.

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