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The anatomy of a ripoff

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Re: The anatomy of a ripoff

#91

Post by tomjen3 »

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/…

Actually you simply offer to pay whatever they would have gotten from the insurance company -- they are likely to get even less if they sue you into bankruptcy.

Re: The anatomy of a ripoff

#92

Post by tankenmate »

yummyfajitas wrote: post #63
sethg wrote: post #44

Earlier quoted context omitted.

The American health-care system thrives in the uncanny valley between the government and the free market. There are all sorts of laws and regulations that prevent normal market procedures from working (for example, emergency rooms can’t turn someone away because they can’t pay), but at the same time, American anxiety over “socialism” has prevented Congress from letting the government take a more active role in actual…

...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…

You could argue that the reason outpatient care is so high in the US is because people who can't afford, insurance or otherwise, for "normal" care only go to the hospital when their condition becomes acute and emergency departments that can't turn away people have to treat them. You could probably argue that in this case acute treatment cost is higher because the primary condition has been left untreated for so long ; xref the stories of poor children dying from tooth abscesses, something that could normally be treated with $15 worth of antibiotics and $25 worth of dental work; tooth pulled, hardly aesthetic but it works. That $40 of timely intervention is probably hundreds cheaper than a child presenting to emergency with septicemia.

Re: The anatomy of a ripoff

#93

Post by rgraham »

pavelkaroukin wrote: post #15

My wife recently had some tests done. Hospital's receptionist forgot to add insurance information to wife's profile, so accordingly to hospital's records she was uninsured. Month later we receive bill for ~$1,400. After quick googling we find that if she would go to any local hospital and pay up front with cash, it would cost her maximum ~$400. Obviously, she went back to hospital to find out what's wrong with them (…

'Something' is indeed wrong when no one can seem to even identify what that is. Opacity is the first problem I suppose.

Re: The anatomy of a ripoff

#94

Post by tomjen3 »

afterburner wrote: post #54
yummyfajitas wrote: post #28

Earlier quoted context omitted.

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

"Too bad"? You like thinking about a $5000 bill when you're headed to the OR, perhaps straight from the ER? You think this is feasible for the vast majority of people?

Yes, because you have that amount in HSA. That is the entire point of the high deductible.

Re: The anatomy of a ripoff

#95

Post by astrodust »

yummyfajitas wrote: post #65
astrodust wrote: post #57

Earlier quoted context omitted.

How does that help anyone in any way?

It creates a downward pressure on health care costs.

In what hypothetical world? It sounds like the hospitals in the US couldn't care less how much they charge people since they'll just sue you into oblivion if you don't pay.

What's the difference between a $1K deductible and a $10K one? How's that going to make one bit of difference?

Consumers have no say in how much the procedures cost. There's no "price pressure" from anyone but the group buyers, those being the insurance companies and Medicare.

Re: The anatomy of a ripoff

#96

Post by tankenmate »

arethuza wrote: post #87
tankenmate wrote: post #74

Earlier quoted context omitted.

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/

If you choose to get elective surgery for a condition rather than waiting in the queue for the NHS your room isn't covered by the Govt, your post-op prescriptions aren't covered, etc. If you do wait however they are covered. If you need corrective surgery afterwards to fix something that went wrong in the first op you normally aren't covered for that by the NHS either.

Re: The anatomy of a ripoff

#98

Post by torontos »

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…

That is a very good point re: medicare.

I was a management consultant in the healthcare industry in a previous life. One interesting study I did found a direct correlation between percent of patients on medicare/medicaid and hospital profitability...

The higher the percent of medicare and medicaid patients, the lower the profitability. The correlation was essentially a straight line.

Re: The anatomy of a ripoff

#99

Post by jellicle »

yummyfajitas wrote: post #63
sethg wrote: post #44

Earlier quoted context omitted.

The American health-care system thrives in the uncanny valley between the government and the free market. There are all sorts of laws and regulations that prevent normal market procedures from working (for example, emergency rooms can’t turn someone away because they can’t pay), but at the same time, American anxiety over “socialism” has prevented Congress from letting the government take a more active role in actual…

...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…

Well, yeah, if you ignore all the studies and only read libertarian blogs, then it's hardly clear. Administration accounts for 31% of healthcare costs in the U.S., and 16% in Canada, for example.

Re: The anatomy of a ripoff

#100

Post by yummyfajitas »

_delirium wrote: post #72
yummyfajitas wrote: post #47

Earlier quoted context omitted.

The RAND experiment disagrees with you. It shows that cost sharing induces people to use 30% less medicine with no significant effects on health. http://www.rand.org/health/projects/hie.html Unfortunately, we never repeated the rand experiment, so it's a bit dated. For some reason we never tried repeating it before pushing massive changes in the law.

"No significant effects on health" isn't entirely accurate; the "average" participant had no negative effects on health, but several of the subgroups did, mainly poor people with chronic conditions who had better compliance with treatment regimens, and better outcomes, in the free-care case. Here's the abstract: http://www.nejm.org/doi/full/10.1056/NEJM198312083092305

I'm familiar with this paper. Unfortunately it's deeply flawed.

The RAND health experiment studied 30 measures of health. Two of them were statistically significantly improved - vision (due to free eyeglasses, p=0.001) and blood pressure (p=0.03).

Simple math shows that 0.97 ^ 30 = 0.4. This means that the RAND experiment had a 60% chance of showing an effect in at least one particular submeasure even if there was no effect in any of them.

(The result on eyeglasses is strong enough to avoid this effect, however. So we can conclude that free glasses help people see better.)

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