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The anatomy of a ripoff

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Re: The anatomy of a ripoff

#81

Post by atirip »

moozeek wrote: post #40
atirip wrote: post #35

Earlier quoted context omitted.

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…

Hmm, thats news for me. Here also self employed are insured. Even homeless are kind of ensured. Ok, if you mean that rare case when you bill in the name of your company, but do not pay yourself any salary, then yes, this is one rare way.

Re: The anatomy of a ripoff

#82

Post by CWuestefeld »

tankenmate wrote: post #74
dsplittgerber wrote: post #43

Earlier quoted context omitted.

I'm from Germany and you do realize that over here (don't know about the exact differences) privately-insured patients (who opted out off the 'mandatory' insurance scheme) basically pay a LOT more for any given medical service just so that patients covered under the mandatory insurance can get treated at all? It's like a giant (inefficient) money redistribution scheme, in all the worst ways imaginable. Regulation doe…

Actually I think you'll find that billing like the kind you see in the US doesn't happen in Germany. The US spends nearly twice as much per capita than Germany for a comparable level of service[1]; this is hard to judge but life expectancy is a reasonable proxy, people in Germany on average live about the same. The UK with near mandatory, see below, universal healthcare the cost of per capita is lower still [1 ibid].…

life expectancy is a reasonable proxy

I disagree. The USA differs significantly from Germany, both in cultural aspects and genetic/racial makeup. Different lifestyles contribute significantly to life expectancy differences, as does heredity.

Re: The anatomy of a ripoff

#83

Post by _delirium »

Symmetry wrote: post #31
rdtsc wrote: post #6

Earlier quoted context omitted.

> 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 a…

The Adderall example is due to our drug-war paranoia more than due to healthcare regulation; Adderall is a Schedule II controlled substance whose production and distribution is micromanaged as a result.

My guess is that those problems would remain even if we completely deregulated healthcare otherwise, because there is very little political support for widespread drug declassification (maybe marijuana will happen in my lifetime, but I doubt much else).

Re: The anatomy of a ripoff

#84

Post by jbooth »

llimllib wrote: post #80
yummyfajitas wrote: post #63

Earlier quoted context omitted.

...when you measure things like life expectancy, Britons are as healthy as Americans. That gives you an idea of how much money is going down the tubes due to administrative inefficiency. It's hardly clear the money is going down the tubes due to administrative inefficiency. It might just be spent on unnecessary medicine, and costs might be higher in the US. According to one fairly decent source, administrative ineffi…

I'm also certain that much of the unnecessary medicine is provided because of the legal climate in the US; doctors practice under the assumption that they will be sued if they don't provide unnecessary medicine.

Also, if you pay a bajillion dollars for an MRI machine, then you amortize the cost over the number of times it's used. The times you use it, it's just the cost of electricity. So there's an incentive to use it a lot.

That still doesn't explain being charged several thousand for an x-ray, though. That's 150 year old technology, this isn't like Dr. House and a team of neurosurgeons at work here.

Re: The anatomy of a ripoff

#85

Post by llimllib »

a5seo wrote: post #8

Bottom line is that if you're middle class and don't have health insurance, a serious accident could bankrupt you. The system was designed with the idea that you don't exist, and would never actually pay the rack rates that hospitals charge. Planet Money had some good coverage of the joke that is medical billing a couple of years ago: http://www.npr.org/blogs/money/2010/07/06/128338526/ex-ambul... http://www.npr.org/…

This econtalk podcast with the CEO of a hospital system in St. Louis is also very enlightening: http://www.econtalk.org/archives/2008/12/lipstein_on_hos.htm...

Re: The anatomy of a ripoff

#86

Post by wildmXranat »

goatforce5 wrote: post #53
jiggy2011 wrote: post #9

Wow , I'm glad I don't have to expend mental energy on stuff like this. Universal Healthcare, get it. It's really good. Honest.

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.

Re: The anatomy of a ripoff

#87

Post by arethuza »

tankenmate wrote: post #74
dsplittgerber wrote: post #43

Earlier quoted context omitted.

I'm from Germany and you do realize that over here (don't know about the exact differences) privately-insured patients (who opted out off the 'mandatory' insurance scheme) basically pay a LOT more for any given medical service just so that patients covered under the mandatory insurance can get treated at all? It's like a giant (inefficient) money redistribution scheme, in all the worst ways imaginable. Regulation doe…

Actually I think you'll find that billing like the kind you see in the US doesn't happen in Germany. The US spends nearly twice as much per capita than Germany for a comparable level of service[1]; this is hard to judge but life expectancy is a reasonable proxy, people in Germany on average live about the same. The UK with near mandatory, see below, universal healthcare the cost of per capita is lower still [1 ibid].…

"In the UK if you opt out of public healthcare you can't mix and match services beyond the GP level, this may change in the future."

What do you mean by this? You can have pretty much any health service privately in the UK if you want to pay for it e.g. from BUPA:

http://www.bupa.co.uk/

Re: The anatomy of a ripoff

#88

Post by jbooth »

CWuestefeld wrote: post #71
jbooth wrote: post #55

Earlier quoted context omitted.

I sincerely doubt that the bean-counters at hospital are losing a ton of money on medicare but are too confused by the large 'revenue' figure to subtract a larger 'expenses' figure and realize they're making a loss. As a matter of fact, I can't recall ever reading an op/ed or anything by a hospital administrator complaining that they're being fleeced by medicare and losing a bunch of money on it. But I've seen a bill…

And I'm telling you that my wife is that bean counter. Her job is (a) budgeting, and (b) getting reimbursement from Medicare and Medicaid. As well as anyone in the organization (which is to say, not too well, because of the deficiencies with cost accounting that I mentioned), she knows those numbers. I don't think a month goes by when I don't ask her this question. Something always comes up, where she's saying "Medic…

Well, I'll take your word for it. I do think that the major problems come from being in a halfway-space between public and private sector for the whole industry, combined with the fact that the entirely-private insurance system breaks any market forces which could lower prices.

Re: The anatomy of a ripoff

#89

Post by llimllib »

jbooth wrote: post #84
llimllib wrote: post #80

Earlier quoted context omitted.

I'm also certain that much of the unnecessary medicine is provided because of the legal climate in the US; doctors practice under the assumption that they will be sued if they don't provide unnecessary medicine.

Also, if you pay a bajillion dollars for an MRI machine, then you amortize the cost over the number of times it's used. The times you use it, it's just the cost of electricity. So there's an incentive to use it a lot. That still doesn't explain being charged several thousand for an x-ray, though. That's 150 year old technology, this isn't like Dr. House and a team of neurosurgeons at work here.

> That still doesn't explain being charged several thousand for an x-ray, though

If you want to try and understand this stuff, you have to abandon the idea of the charged cost of a procedure relating to how much it cost to provide. It's truly depressing.

This econtalk podcast does a good job diving into the nightmare of non-prices in the medical system: http://www.econtalk.org/archives/2008/12/lipstein_on_hos.htm...

Re: The anatomy of a ripoff

#90

Post by Mc_Big_G »

The real scam perpetrated by hospitals and doctor's offices is rebilling.

It works like this:

1) They send a bill with no information about the services performed.

2a) You waste your time tracking down what it was and then pay it.

OR

2b) You pay the bill without wasting your time to verify.

3) They wait somewhere between a month and 6 months.

4) After receiving payment, they bill you again for the same services.

5a) You waste your time tracking down the services and the fact that you already paid. Then you waste more time calling and forcing them to stop billing you. You get an "Oops, sorry! I can't imagine how that happened."

OR

5b) You pay the bill without wasting your time to verify.

Repeat steps 3 through 5 until they've sucked as much time and money out of you as possible.

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