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The anatomy of a ripoff

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Re: The anatomy of a ripoff

#31

Post by Symmetry »

rdtsc wrote: post #6
CWuestefeld wrote: post #3

My wife is the manager of budget and reimbursement at a hospital, and from many conversations with her, I can imagine that this article is accurate. However, if I were writing this, I would have given greater emphasis to the effect that Medicare has on these problems. The article does mention that Medicare typically pays fees that are below actual cost for the procedures, and that hospitals must therefore increase ch…

> Medical care is the most highly regulated industry in the economy, and so nothing you see happening is going to bear very much resemblance to reality. You make it sound like one follows from the other in an obvious way. Can you expand on why that would be?

As just one example, look at the RBRVS: http://www.slate.com/articles/news_and_politics/prescription...

Paying people on a cost-plus basis provides them with an incentive to maximize costs, whether they're doctors or defense contractors.

Then there's also the FDA's use of production quotas for drug production. We had a big shortage of Aderall recently because the FDA has to give permission ahead of time for a given amount of production of the drug for each company. And when the FDA decided that one of the producers wasn't up to snuff and was no longer allowed to make the drug, it failed to raise the quotas of the other producers to compensate.

To the extent that you run a section of the economy like the USSR was run, you shouldn't expect it to be run efficiently. The US healthcare system would still have quite a ways to go before it becomes quite that bad, but its closer than most people seem to think.

Re: The anatomy of a ripoff

#32

Post by klenwell »

jerrya wrote: post #17

I have spent a week in a hospital twice, once in the late 90s, once in the lates 00s. Different hospitals, different health plans. Here's the thing: in the 90s experience, I received a complete itemized bill, organized by time and day, for everything that was done to me. I didn't have to pay, my insurance did, but I received copies of the bill. In the 00s, I received virtually nothing. Again, my insurance paid, and I…

I agree. I've been active in helping my grandparents manage their affairs the last few years and I find it interesting how frictionless it is for them, under the Kaiser HMO, to get medical services, especially prescriptions. I find it a little too frictionless at times.

They sometimes show me the paperwork Kaiser gives them, but I don't remember ever seeing an itemized bill. I'd find it insightful, as I think they would too, to see a list of expenses. I'd also like them, and everyone (especially seniors), to see how much of those costs the government bears.

Although I don't get too deeply into the politics of it with them, my grandparents are part of that Fox News senior demographic that would probably happily repeal "Obamacare" while being kept blissfully unaware of the benefits they enjoy because of government assistance.

Re: The anatomy of a ripoff

#33

Post by _delirium »

yummyfajitas wrote: post #28
joezydeco wrote: post #12

Something must be tightening up somewhere, though. Just before my daughter went through an outpatient surgical procedure, the hospital (which was acting as the surgical facility only here) called my wife. They noticed we had a high-deductible plan. Would we be willing to prepay part of the O/R costs now? I talked to the hospital at length to try and understand this change in procedure. Apparently the number of patien…

This is why high deductible insurance offers the best hope for cost control. Too bad it becomes illegal in 2014.

It depends on what you mean by "high deductible", but the Affordable Care Act specifically includes a circa-$6000 deductible option that would satisfy the individual mandate. See: http://www.kff.org/pullingittogether/What-Conservatives-Won-...

Re: The anatomy of a ripoff

#34

Post by lflux »

moozeek wrote: post #5

As far as I can tell from the facts given in the EU you would have paid about the same amount the author had to pay out of his own pocket (~ 700 USD). If you had no health insurance at all.

Far from. In Stockholm, for a child she would have paid 120 SEK (~17 USD) for an ER visit. That is assuming she was a resident or in possesion of an EU/EEC insurance card. Going price for an ER visit without EU insurance would be 1650 SEK (~240 USD). So not close even there.

Re: The anatomy of a ripoff

#35

Post by atirip »

moozeek wrote: post #5

As far as I can tell from the facts given in the EU you would have paid about the same amount the author had to pay out of his own pocket (~ 700 USD). If you had no health insurance at all.

First, kind Sir, describe me believeable scenario about how exactly you managed to live uninsured in EU and then we shall talk.

Re: The anatomy of a ripoff

#36

Post by Symmetry »

yummyfajitas wrote: post #18
johnschrom wrote: post #10

This article only scratches the surface of how messed up our health care system is. I'd be shocked if either hospital system was able to figure out how much money the writer's son actually cost the hospital... the organizations I've worked for take at least a year to calculate cost (if they ever successfully do it), making (as CWuestefeld said) many of their other calculations come largely from guesses. Sometimes tha…

Sometimes that guess is as simple as "just multiply what Medicare pays by 3... Interestingly, medicare does roughly the same thing - multiply the private sector cost by some number less than 1.

This seems apropos: http://www.michaeleisen.org/blog/?p=358

Re: The anatomy of a ripoff

#37

Post by defen »

rdtsc wrote: post #6
CWuestefeld wrote: post #3

My wife is the manager of budget and reimbursement at a hospital, and from many conversations with her, I can imagine that this article is accurate. However, if I were writing this, I would have given greater emphasis to the effect that Medicare has on these problems. The article does mention that Medicare typically pays fees that are below actual cost for the procedures, and that hospitals must therefore increase ch…

> Medical care is the most highly regulated industry in the economy, and so nothing you see happening is going to bear very much resemblance to reality. You make it sound like one follows from the other in an obvious way. Can you expand on why that would be?

I think part of the problem is that "highly regulated" is an ill defined term. For certain definitions of "highly regulated", the NASDAQ is highly regulated, yet we don't see much price distortion there. The "problem", I think, is with the nature of the regulation, and the nature of the supply/demand equation for medical care.

One simple example, which I don't really have time to explain here, is the health insurance system which makes it so that people generally do not consider price when purchasing medical care. Of course that is going to lead to price distortions.

Another simple example is the inflexibility in the supply of doctors, which is ultimately due to government regulations (many would argue that this is a good thing)

Re: The anatomy of a ripoff

#38

Post by yardie »

yummyfajitas wrote: post #28
joezydeco wrote: post #12

Something must be tightening up somewhere, though. Just before my daughter went through an outpatient surgical procedure, the hospital (which was acting as the surgical facility only here) called my wife. They noticed we had a high-deductible plan. Would we be willing to prepay part of the O/R costs now? I talked to the hospital at length to try and understand this change in procedure. Apparently the number of patien…

This is why high deductible insurance offers the best hope for cost control. Too bad it becomes illegal in 2014.

I think it only delays the inevitable and ends up making things worse. If people don't have the money for surgery (and really how many of us can pull ou $5000, right no). They'll delay it. Delay it too long and that $4000 surgery becomes a $50000 intensive care, emergency operation.

Re: The anatomy of a ripoff

#39

Post by _delirium »

viandante wrote: post #13
moozeek wrote: post #5

As far as I can tell from the facts given in the EU you would have paid about the same amount the author had to pay out of his own pocket (~ 700 USD). If you had no health insurance at all.

As far as I know in EU public insurance is mandatory, so you would never pay such ammount.

It varies a lot by country. In Denmark, all hospital visits are free to anyone, whether a resident or visitor. In other countries, non-EU visitors to an ER might pay substantial amounts, though usually still quite a bit less than in the US. Also, some EU countries tie insurance to payroll-tax contributions, so the unemployed may not be covered.

Re: The anatomy of a ripoff

#40

Post by moozeek »

atirip wrote: post #35
moozeek wrote: post #5

As far as I can tell from the facts given in the EU you would have paid about the same amount the author had to pay out of his own pocket (~ 700 USD). If you had no health insurance at all.

First, kind Sir, describe me believeable scenario about how exactly you managed to live uninsured in EU and then we shall talk.

That's pretty easy, at least in Germany: if you are self employed you are not automatically insured, you need to pick a plan from a private insurance company on your own (or go with one of the expensive "voluntary" plans of the public insurances). If you don't, you simply don't have insurance.

I don't know what happens when they find out that you're uninsured, however it's possible to have no health insurance.

At the doctors or at the hospital just say you have private insurance and you'll get a invoice after the treatment.

My whole point is, the invoice amount would be not quite close to what that Amarican hospital charged.

[Edited for clarification]

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