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The anatomy of a ripoff

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Re: The anatomy of a ripoff

#181

Post by arethuza »

krschultz wrote: post #162
goatforce5 wrote: post #106

Earlier quoted context omitted.

The out-of-pocket was 0 in the sense that my tax is already paid and there was no additional expense in me choosing to go to hospital to be checked out. So, yes, I pay for it. A big chunk of my pay packet goes to tax, but i'm happy knowing I can receiving good treatment without having to work out if I can afford it. I'm also happy it means those less fortunate than myself (re: current income levels) will receive the…

And I really can't emphasize enough how much it sucks to do a cost/benefit analysis on going to the hospital or not. A couple of years ago my girlfriend and I were on crappy insurance (i.e. catastrophic coverage only) because that's all we could afford. She had a medium level concussion and we were debating the cost of going or not. Going and getting a cat scan was a sure way to spend $2,000 that we simply did not ha…

In 1952 Aneurin Bevan, arguably the architect of the UK NHS, wrote a book about his beliefs - interestingly enough he called it In Place of Fear which pretty much sums up what the NHS achieved:

http://en.wikipedia.org/wiki/Aneurin_Bevan

Re: The anatomy of a ripoff

#182

Post by EdiX »

wildmXranat wrote: post #86
goatforce5 wrote: post #53

Earlier quoted context omitted.

Due to my own stupidity I fell off my bike on the weekend. A few minutes later I realised my little finger was swelling up and hurting a whole lot. Universal healthcare let me go to a hospital get 3 x-rays and a doctor to tell me nothing was broken. Took 3 hours, but multiple people apologised for it taking so long while I was there (to be honest, I thought it was quick. A sore finger must just about be last on the l…

Huh ? I'm glad that your finger is better, but you procedure was not 'out-of-pocket' $0. Here in Canada, where the similar treatment would be $0 at the time of treatment, I would've paid in thousands already into the health care system in federal/provincial pay deductions. I consider, the money lost to be a continuous out of pocket expenditure. I still like this system more tbh.

In the USA health insurance terminology "out-of-pocket" refers to what you have to pay for some procedure in addition to what you normally pay for insurance coverage. With the insurance I had when I was in the USA a visit to the GP would be 30$ out of pocket, on top of the monthly insurance fee (that was 300$, I think).

Re: The anatomy of a ripoff

#183

Post by intended »

CWuestefeld wrote: post #115
jellicle wrote: post #101

Earlier quoted context omitted.

The person you're responding to believes that if medical charges are vastly different between providers it must be due to evil government regulation, because after all in other sorts of stores we never see wildly varying prices for the same item and healthcare, where people have plenty of time to comparison shop (even if you're choking on turkey, you still have a few minutes to contact the various local hospitals and…

The person you're responding to believes that The person he's talking to doesn't believe that putting a strawman argument into someone else's mouth is an honest debate tactic. This question has nothing to do with ideology. As a matter of pure logic, regulation changes what the market is doing naturally; that's the whole point of the regulation. This is a non-judgmental conclusion. One doesn't have to say that the mar…

Bit late to the conversation, and somewhat pedantic, do forgive -

Going from : >>This is a non-judgmental conclusion. One doesn't have to say that the market state was good or bad, or that the regulated state is good or bad. Simply that a regulated market differs from a free market. That's it.

to

>>Now, given that the system is highly regulated, it's clear that the regulators have screwed up.

is making a jump.

It is not a necessary that the regulators messed up - it is also possible that the parties being moderated, are actively subverting the system.

/pedant

I will agree with your point behind it all - ie that in such a system it is LIKELY that there is fault by the regulators. This type of fault, the extent of responsibility for the final outcome, these are complex questions which need more than just stating that the regulators were out of line.

You could say that X and Y are responsible for crime A. The punishment/responsibility would depend on a variety of factors. That is the question that requires answering.

Re: The anatomy of a ripoff

#184

Post by cstross »

shabble wrote: post #173
cstross wrote: post #78

Earlier quoted context omitted.

The fixed cost per visit is not a payment for treatment, but a tax; it's notionally there to stop people using the system excessively. (See also the prescription tax in England, although there the average cost of a prescribed medicine <= the prescription tax. Here in Scotland we abolished the NHS prescription tax a year ago; the system didn't subsequently collapse under the weight of freeloaders asking for prescripti…

Even before that there were pre-payment schemes, I think you could get a 3 month or annual card for ~£15/£35 or something. Helpful mostly to people with chronic conditions (IIRC unemployment/disability benefits tend to include relief of prescription charges). I was quite happy with the prepayment scheme, so really the only difference is I now pay them £60/yr (quarterly cards, oh the optimism) less directly. As an add…

The 16/32 limit on paracetamol (US: acetaminophen) purchases over the counter is there because paracetamol is highly hepatotoxic and in fact kills more people (through liver failure) every year in the UK than any other drug except alcohol or tobacco.

Obviously it's a bit different for you as you're receiving it under medical supervision for a chronic condition, but imposing that cap on ad-hoc purchases cut the death rate (by both pre-planned suicides and idiots who didn't take the health warnings on the label seriously) by around 20-25%.

(Personally, speaking as an ex-pharmacist, I avoid the stuff.)

Re: The anatomy of a ripoff

#185

Post by Ex-PraliteMonk »

How much of the silliness in U.S. health care is caused directly by the tax code? For instance the largest health insurance company in my area also owns several hospitals. The hospital charges the insurance company for a procedure. The insurance company pays only half that amount. The rest I believe is written off by the hospital as a loss which lowers their taxes. But both the hospital and the insurance company are the same company.

Re: The anatomy of a ripoff

#186

Post by CWuestefeld »

intended wrote: post #183
CWuestefeld wrote: post #115

Earlier quoted context omitted.

The person you're responding to believes that The person he's talking to doesn't believe that putting a strawman argument into someone else's mouth is an honest debate tactic. This question has nothing to do with ideology. As a matter of pure logic, regulation changes what the market is doing naturally; that's the whole point of the regulation. This is a non-judgmental conclusion. One doesn't have to say that the mar…

Bit late to the conversation, and somewhat pedantic, do forgive - Going from : >>This is a non-judgmental conclusion. One doesn't have to say that the market state was good or bad, or that the regulated state is good or bad. Simply that a regulated market differs from a free market. That's it. to >>Now, given that the system is highly regulated, it's clear that the regulators have screwed up. is making a jump. It is…

It is not a necessary that the regulators messed up - it is also possible that the parties being moderated, are actively subverting the system.

As I see it, that is a problem with the regulation.

By analogy, when a hacker breaks into your system, you can't say, "our security checks weren't wrong; the users just weren't supposed to enter those inputs". It's your job to anticipate all the possible bad inputs, and guard against them.

Similarly, it's the job of the regulators to anticipate all possible routes around the regulations, and account for those.

Now, a bit of thought will lead to the conclusion that this is impossible except in all but the most trivial cases. I submit that this does NOT give us leave to shrug and just go through it anyway. Instead, it should force us to step back and consider whether the intended benefits of the regulations are great enough to counterbalance the cost of the complications that are certain to occur down the road.

(and I note a certain irony in your pseudonym "intended", since the problem here is UNintended consequences)

Re: The anatomy of a ripoff

#187

Post by dbcfd »

Tsagadai wrote: post #180
dbcfd wrote: post #141

Earlier quoted context omitted.

Price gouging is an aspect of capitalism. Demand goes up, price goes up. Without market interference, this should force demand down. Health care can't be forced down by price (at least, life saving health care), so you either have to stop providing care to those that need it but can't pay, or pass along the costs to others.

Health care costs can be forced down. The supply of doctors, nurses and other health professionals can be greatly increased (with free medical education or immigration, for example). Medicines can be mass produced by walking around (or over) copyrights and patents. Increasing competition (making it easier to switch provider, building more hospitals and facilities, etc. All these approaches have been tried, many of th…

Yeah, that's why I said they can't be forced down by price. The supply/demand side is a whole other issue.

Medical school is entirely too expensive, which limits doctors going into general or emergency care, which causes further strain on the system.

Re: The anatomy of a ripoff

#188

Post by shabble »

cstross wrote: post #184
shabble wrote: post #173

Earlier quoted context omitted.

Even before that there were pre-payment schemes, I think you could get a 3 month or annual card for ~£15/£35 or something. Helpful mostly to people with chronic conditions (IIRC unemployment/disability benefits tend to include relief of prescription charges). I was quite happy with the prepayment scheme, so really the only difference is I now pay them £60/yr (quarterly cards, oh the optimism) less directly. As an add…

The 16/32 limit on paracetamol (US: acetaminophen) purchases over the counter is there because paracetamol is highly hepatotoxic and in fact kills more people (through liver failure) every year in the UK than any other drug except alcohol or tobacco. Obviously it's a bit different for you as you're receiving it under medical supervision for a chronic condition, but imposing that cap on ad-hoc purchases cut the death…

Yeah, I'm well aware of the reasoning, and I'm scrupulously careful about how often I take it, and have essentially given up alcohol for the last year or more out of paranoia (erm, justified caution). Dying slowly of liver failure over several weeks doesn't sound like my idea of fun.

That fatality reduction sounds incredible though. Since just about every corner shop sells the stuff, I'm surprised it cut the suicide rate by that much - I'd have thought it more likely the aforementioned idiots who think OTC means it's harmless, and a handful is just the thing for yesterdays hangover before hitting the pub tonight.

Out of curiosity, do you have a reference? I'm wondering if it breaks down the figures for the "nuke-your-liver trying to get high on codeine" crowd against the others as well.

Re: The anatomy of a ripoff

#189

Post by cstross »

shabble wrote: post #188
cstross wrote: post #184

Earlier quoted context omitted.

The 16/32 limit on paracetamol (US: acetaminophen) purchases over the counter is there because paracetamol is highly hepatotoxic and in fact kills more people (through liver failure) every year in the UK than any other drug except alcohol or tobacco. Obviously it's a bit different for you as you're receiving it under medical supervision for a chronic condition, but imposing that cap on ad-hoc purchases cut the death…

Yeah, I'm well aware of the reasoning, and I'm scrupulously careful about how often I take it, and have essentially given up alcohol for the last year or more out of paranoia (erm, justified caution). Dying slowly of liver failure over several weeks doesn't sound like my idea of fun. That fatality reduction sounds incredible though. Since just about every corner shop sells the stuff, I'm surprised it cut the suicide…

Best reference I can find online is here:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...

It's important to read beyond the initial summary, though, as this is a rather nuanced report with some interesting side-observations. For example: A study in London three years after the regulations were introduced found that 46% of people presenting with overdose had purchased potentially toxic amounts of paracetamol in a manner contravening the spirit of the 1998 legislation.

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