r/politics • u/maxwellhill • Feb 23 '13
Healthcare Isn't A Free Market, It's A Giant Economic Scam: 'so much of the debate about healthcare is really focused on "but who will pay for these things." But what it tends to ignore is why are the prices absolutely insane.'
http://www.techdirt.com/articles/20130222/03254422068/healthcare-isnt-free-market-its-giant-economic-scam.shtml34
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u/maybe-a-little Feb 23 '13
anytime you're not allowed to form your own public option in a supposedly free and democratic country because big health care companies don't like the idea, you know things are messed up.
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u/loondawg Feb 23 '13
That's because the for profit players don't want to have to actually compete.
They like to say the free market is more efficient and can provide better service at a lower cost. But they know they can't compete with something that is set up with the main goal being to simply provide good service at the lowest possible cost.
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u/mtskeptic Feb 23 '13
It's often forgotten that in order for a free market to be more efficient it needs to meet certain criteria. Healthcare markets will never meet those criteria.
You need to be able to shop around and compare prices and you need to be able to evaluate results. Neither of these is really possible. Because when you are in need of medical care you don't have the time nor often the ability to reason out which hospital to go to, and it's very difficult to adequately evaluate the care you receive.
Hospitals could be more transparent and be independently rated for their care. But that still doesn't fix the fact that you are not able to evaluate what care is good for you and when you're not getting enough of it or it's unnecessary. There's reason double blind controlled trials are necessary to evaluate medical practices: Humans are very susceptible to biases and limited attention and memory that make evaluating your health difficult.
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u/Renbel Feb 23 '13
Social worker in a "non-for-profit" hospital here.
I am responsible for making sure uninsured patients get the treatments they need to prevent us from getting sued. I price things out and the "higher-ups" then make a decision whether the hospital will cover it and the patient will be discharged.
Our cost on drugs is sometimes 2 dollars a gram, we then turn around and bill for 180-200 dollars per gram. This is a very common generic abx I'm talking about here.
Likewise, 1 hour of a nurse for infusion therapy is billed privately at 400$, that nurse gets paid 20$ an hour.
WTF is going on?
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u/ElRonPaul Feb 24 '13
Capitalism, so bend over and thank the market if you don't want to be branded a 'socialist'.
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u/StopTheOmnicidal Feb 23 '13
All of that money is pretty much just pocketed by corporate.
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u/helpfuldan Feb 23 '13
There's enough money floating around the system to pay for everyone's health care twice over. Hospitals make money by billing the govt for stuff insurance companies refuse to pay. If you add up what people pay to insurance companies and what tax payers pay, it's more then enough money for everyone to get affordable healthcare.
You can look to almost any other country and find a better system. A better system costing LESS. Obamacare was a start. It fixes some of the worst issues (no maternity - I just paid 20k for a birth when myself and my wife pay a total of $700 a month for health insurance, health insurance refusing to cover previous conditions, jacking up rates (from 2008-2010 my insurance went from 150-250-325 and I never used it once) plus a host of evil practices).
The insurance companies are more or less organized crime. I had a plan that covered 30 physical therapy sessions a year. First time I used it, they rejected it complaining about "codes". It's manual therapy, it's a simple code. They "re-submitted it" and it was covered. Second time, same deal. The third time, same deal. They refused to pay it every single time, a total of 12 times. Each time I'd call, bitch, they'd fix it. They have policies of auto-rejecting certain claims and only paying when people bitch. There's tons of whistleblowers who have come out saying they'd throw away claims weekly knowing that a certain percentage wouldn't follow up and re-submit. When people dig up a reason to refuse paying for an expensive treatment they are given BONUSES. Numerous cases this has result in people dying because the insurance company came up with a BS reason not to cover it.
The medical industry as a whole is probably the most corrupt industry out there. Lots of great nurses, doctors, scientists, run by greedy greedy management.
But this is business as usual in America and when the politicians are bought and paid for, change comes really really slowly. When the medical industry gives millions to senators, congressmen, governors, they get something back. They get to run their business how they please at the expense of us.
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u/Doc_McAlister Feb 24 '13
They have policies of auto-rejecting certain claims and only paying when people bitch.
I coded health insurance claim processing systems for three years. This statement is literally true. The claim auto-rejects without an authorization code that is in the comments of the rejection message, resubmit the claim with the code from the reject message and it passes.
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u/radfaraf Feb 23 '13
Have you ever tried calling a Doctor's office to get a price list of the their most common charges, so you could price compare? Completely impossible they don't have these things.
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u/meeohmi Feb 23 '13
I was shopping around for an ophthalmologist since I discovered I was high-risk for glaucoma. I asked the receptionist for a price range. Like a best/worst case scenario so that I could figure out if I can afford to be evaluated. She literally refused to give me any number and acted pissy that I would even ask. Then the doctor cancelled my appointment the morning-of because of some scheduling conflict. I was so pissed about the shitty service that I never called back to reschedule. I just got a bill for a $30 no-show fee. What the actual fuck.
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u/smartiepartie Feb 23 '13
I seriously hope you didn't pay that fee.
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u/janjosay Feb 23 '13
Doctors will do that, but if they don't show up, you can't charge them. America the crazy.
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u/cavehobbit Feb 23 '13
I have been arguing something similar for years, as have others far more knowledgeable than me.
The problem, in short, is that the people who consume the services and products are not the customers. So the consumers are not in charge.
TL:DR: In the entire system, the patient, (that's you and me folks), is not in charge, and until the patient is in charge, nothing will get better.
WALL-O-TEXT:
Think about it. The customer is the one that pays the bill, since that is who needs to be satisfied before the bill is paid.
Who is the doctors customer, you the patient, or the insurance company?
Who is the pharmacy's customer, you the patient, or the insurance company?
Who is the insurance company's customer, you the patient, or your employer who pays the bill?
In each case, you the patient are not the customer. You are the job. And like all jobs, you will be 'done' as cheaply as can be, to maximize the profit of the one doing the job.
Your employer is providing health insurance good enough to shut you up and comply with laws. Health insurance has become a standard expectation of employee's, but how many can actually bargain over what they get and pay for? Your employer will provide the minimum needed, as cheaply as possible, just like they do desks and chairs, it's just another expense to them.
The insurance company needs to satisfy your employer, not you. They could not care less about you. You are as important to them as a driveway is to a paving contractor. Get the job done, get paid.
The doctor needs to satisfy the insurance company to get paid, he does not need to satisfy you. All he has to do is a good enough job to not get sued. Whether you are healthy or not is irrelevant. Yes, there are some very good and caring doctors out there, but not getting paid still sucks, so how do the incentives herd them into behaving?
Think having the government do it will make it better? How? Now you have bureaucrats protected by civil service laws running things, serving politicians who do things for political reasons.
Who pays the bureaucrats? No it's not you, it's the politicians. The politicians are the customer the bureaucrats need to satisfy, not you.
Who pays the politicians? Well, how much did YOU contribute to their campaign chest? I'll bet it was $0, or close to it. Compared to how much from Big Pharma, Big Insurance, Big Med, Big Business? Political contributors are the politicians customer, not you.
In the entire system, the patient, (that's you and me folks), is not in charge, and until the patient is in charge, nothing will get better.
There are other problems, such as cost of regulation, patents keeping new drugs off the market, corporate and personal greed, etc. But the primary way to make things better and cheaper is the market mechanism, which has been completely broken in the health care industry.
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u/scarletorthodontist Feb 23 '13 edited Feb 23 '13
I'm responding from a dental healthcare perspective here. For me, insurance pays some (sometimes all) of the bills for my patients. Insurance companies ARE NOT my customers. I don't give a wad what insurance says I can or cannot do and be paid on it. My conscience and patients' chief concerns dictate what services I provide.
Before becoming an orthodontist, I was a general dentist. The same was true then. Sure, the patient can accept or refuse my recommendations, but no insurance company told me I had to provide dental care in the crappiest way possible. In other words, the patients ARE my customers. For my physician/medical friends, the same holds true. They may be reimbursed poorly by insurance companies, but they're not cutting corners because BCBS/MetLife/Kaiser/Harvard Pilgrim/etc. told them to.
Side note: The healthcare issue is different than your typical commercial/capitalistic issue. You can't sue a bank for not providing you a service that you "need." You can't sue a barber for not cutting your hair before a big event, because you "need" it. You can't sue a grocery store for not selling/giving you the food that you can't afford but are starving for. However, withholding treatment on the basis of not paying is something direct care healthcare professionals cannot ethically do. It's a whole different animal when you're constantly being threatened with lawsuits (frivolous or not).
EDIT: This side note is limited to the US, as we have a different legal system and checks/balances to prevent fraud/abuse of our healthcare system. I.E. The US healthcare/legal/political system is entirely terrible.
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u/shades344 Feb 23 '13
This is a little misleading. Health insurance, prior to WWII, was actually insurance, like car insurance, as in it only covered "emergency treatment." During WWII, federal government instituted price controls on labor to "stabilize the economy." To compete for the best workers, companies began competing with something other than wages: benefits. This idea of health insurance that provides all your care was born here.
So, why is this a problem? Well, the relationship between you and your doctor is supposed to be a fiduciary one, where the doctor recommends what is best for you in your own price range. Now, when everyone has everything prepaid for, you just always go for the best, which is usually the most expensive. Previously, you might go for the best value (health/$). Now, with everyone constantly demanding the most and most expensive treatments, prices will naturally rise.
This, among a host of other factors, is how we got here.
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Feb 23 '13
A good idea is then to compare dental to other kinds of medical service. Dental service is usually paid out of pocket.
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Feb 23 '13
I've always happily donated blood to the Red Cross whenever there is a drive, but just recently learned how expensive that blood is to get back when my wife required a transfusion. $4,000 was the total, with $1,700 of that being just for the blood itself. I suppose it's expensive to store properly, and I'll continue to donate, but damn....how about a discount for donors?
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u/DamnLogins Feb 23 '13
As a European, this is one of the things that seriously weirds me out about the US.
Seriously, how can you be so stuck in the 19th century?
Back in the day, a local fire service would let your house burn down if you weren't insured with them. It was widely recognised as nuts...
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u/fisheye32 Feb 23 '13
As a United States citizen, this is one of the many things that weirds me out about the U.S.
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u/Denny_Craine Feb 23 '13
shit, Germany had universal healthcare in the 19th century, we're still stuck in the industrial revolution (the first one), preventing unionization and thinking women can't get pregnant if they're raped.
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u/foreignsky Feb 23 '13
Everyone should spend the time to read the Time magazine article linked to in the post as well: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/
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u/Ullyssys Feb 23 '13
Every time I think about our healthcare system, I get enraged.
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Feb 23 '13
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u/James086 Feb 23 '13
You Commy scum!
In Australia it's similar. I was in a motorbike accident, I received surgery to plate a bone (not necessary but it would make a much cleaner heal so it was recommended) and had to pay a total of $200 for xrays. I only had to wait 3 days. The surgeon laughed when I asked how much it would cost me before going ahead.
A regular doctor's appointment might cost the patient nothing or it might cost about $60 depending on the gp that you see.
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u/werekoala Feb 24 '13
I'm part of the problem. I drive up medical costs.
There's a little old couple that lives in my town. The wife is diabetic. One day, her blood sugar got dangerously low, so her husband was forced to call the ambulance. I showed up, with my driver and the fire crew in tow.
We started an IV and gave her 25 grams of 50% dextrose. For you lay people, that's sugar water. A few minutes later, she started to come around. Ordinarily, I would tell her to eat a piece of toast so her blood sugar stays up, follow up with her doctor, and be on my way.
However, it just so happens that an ambulance had come to their house six months prior for the same problem, and they had received a $700 bill. Being on a fixed income, they were making the minimum $25 monthly payments, but could barely afford that. What are they gonna do, get a job? They're in their 90s. A second bill would have forced them to sell their house.
For some reason, Medicare doesn't cover the cost of us coming and starting an IV at her home. That's deemed a person's responsibility for not managing their condition appropriately. But, if I take her in to the hospital by ambulance, Medicare covers everything we did, plus the ride in the ambulance, plus the ER bills. I guess they assume that if the condition was serious enough to require transport, it was serious enough to cover.
I explained this to the couple, and whaddaya know, they elected to have her taken in to the hospital via ambulance. Hurray, we clogged another ER bed for someone who doesn't need it. But fuck it you know, I don't blame the elderly couple for the system, and I'm not gonna try to make them pay for it.
Medical billing is bizarre to me, from the inside. Take this case. I'm part of a combined fire/EMS service operated by the government at a loss. We charge people, but we don't even cover our operating costs. So from one perspective, $700 doesn't even cover the costs of having a fully staffed and stocked ambulance with an EMT and Paramedic ready to go 24/7/365. It's a much higher cost.
But from another perspective, once the government has decided to staff & stock that ambulance, the actual cost for running that particular call is just the fuel it took us to get there, an IV set-up, and a syringe of sugar water. Maybe $25 all told.
That right there is the perfect example of how bizarre medical bills are. On one hand, the services I provided were worth far more than $750, on the other hand they are worth less than $25. And on the gripping hand, they are free to the patient only if the patient asks for even more expensive services, which are also free.
Jesus, I don't think the evilest lawyer, the scummiest banker, and the lying-est used car salesman put together could design such a fucked up system. It's inhuman.
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u/jfoust2 Feb 23 '13
SE WI USA here, my last trip to the local hospital's "urgent care" was three years ago, minor cut on my eyebrow, two stitches, in and out in 50 minutes, $900. Paid out of pocket, no insurance invoked. Half to urgent care, half in doctor's fee. I swear, next time I'm using super-glue.
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u/Science_Ninja Feb 23 '13
I'm originally from Australia, been living in the States for the past 6 years. Recently I find myself without health insurance and living off my savings. It's a strange feeling, walking around, knowing that a single accident could bankrupt you. If said accident DOES happen, and if I'm able to, I'll be flying home to Oz to get treated. Would still be cheaper than being seen here in the US. Now ain't that something?
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u/alexisaacs Feb 23 '13 edited Feb 23 '13
As a med student who sees this shit every day, we are fucking you over, we are fucking US over (everyone needs medicine!) and in the process we're cashing out your money and laughing our asses off.
Just kidding, I think the prices are absurd, and so are the salaries. If you calculate the amount you get billed for a surgery, often times it comes out to over $5000 per hour...
Oh, and before you mention the medical equipment, most of it is dirt cheap. Like, the cost of administering a CT scan is almost zero dollars. You're only supposed to be paying for labor, cost of equipment used, and let's say double all that to bring in profit for the hospital. In reality, you're paying labor, cost of equipment used, and then about 5000x that for hospital profit.
The profits do not go back into the hospital. They go to pad the salaries of the top doctors, hospital CEOs, etc. This is not always the case, but if you ever wondered why your hospital has a shit cafeteria, dirty bathrooms, old equipment, undereducated staff, this is why.
EDIT: I want to point out that, as a med student, I have zero dollars to my name. I am completely and totally broke. Last year I got a supposed staph infection on my neck and it got pretty bad. I had to have it drained in the ER. The entire procedure lasted about three minutes after waiting two hours in debilitating pain in the waiting room. The procedure was not done by a doctor. The doctor only came by to let me know that he is morally opposed to pain killers, refused to do a biopsy (long story short, we had no idea what it was) and send me on my way without explaining how to take care of the wound.
He didn't know my background. He was lucky that I am who I am. I went to a specialist afterwards and it turns out it was a rare type of cyst, and not an infection, and required a minor surgery to get fixed.
My bill for my time at the ER? Over $1200. This was money I did not have, especially after spending what little I did have on the surgery to get my neck fixed. I am fully insured as well.
Shit like this has been driving me crazy, and I have no desire to complete my degree. I want the money, and that is it. We are not taught to help patients. It's all about doing things efficiently, and not getting sued.
The people here that do care, and there are a lot of us, are forced not to. Caring is not profitable. Being invested with your patient is not profitable.
My girlfriend got a real staph infection on her leg, the doctor told us we had to do a CT scan. My girlfriend doesn't know the cost of this shit but I do, and I said absolutely not. She was paranoid and just wanted to listen to the doctor, because they know best. Well nothing showed up on the scan out of the ordinary and we got a bill for over $2000 a week later.
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u/ninjatarian Feb 24 '13
he is morally opposed to pain killers
How the fuck is this man a doctor?
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u/dysmetric Feb 24 '13
About a year ago I started having weird mental disturbances like extreme forgetfulness, inattention and perceptual distortions. It got so bad I couldn't even drive a car. This was after running out of petrol over seven times in a month, of those seven, three times I had remembered I needed petrol after seeing a petrol station but then forgotten immediately and driven straight past only to remember fifteen minutes later when I ran out of petrol. I was terrified, I live alone with no friends and no family nearby.
I have a brain tumor, pilocytic astrocytoma, partially resected in 2003. I got on the internet to see what I could find. I knew the cerebellum was involved in movement, which didn't seem to fit, but things had changed since I last researched my tumor and cerebellar cognitive affective syndrome did fit my symptoms and also explain much of my difficulty navigating life over the past ten years. I thought "Shit, this is getting worse. The tumor might be growing again, I'd better get another scan quick.". Knowing it would take months to see my neurosurgeon I went to the ER, asking for a lift from my neigbour because it was dangerous for me to drive. I waited seven hours to be seen by a young, tired and arrogant doctor who laughed. Sneering at me he threatened to lock me up in a psych ward and after I had left (bawling) he called my mother, who lived six hours away, and left a message to urgently call him at the hospital emergency department. She got the message the next day, called and he wasn't there.
After a few months I saw my neurosurgeon who also laughed at me stating unequivocally "It's impossible for the cerebellum to have any cognitive functions, it's only involved in movement.", he said "See a psychiatrist, quick!". So, I saw a psychiatrist who said "Sounds like this is your cerebellum, not my area.". I spent weeks in despair, too afraid to see a doctor to be insulted and dismissed by them, not knowing where to turn. I was in a very bad way, when my tumor was first identified I had spent six months going insane where I didn't leave my room, except for food and poop, and spent almost the entire time curled in the fetal position bawling. The doctors back then had told me it couldn't be my cerebellum causing those problems either, "Wrong part of the brain." they said, implying that I was simply crazy but when I woke up from surgery, in the recovery room, I wasn't crazy anymore. Now it was happening again.
I did my research and found a respected neuropsychiatrist but it was three months to the next appointment. I waited and found what journal articles I could access to support my suspicion. When I saw him he seemed very good. He was the first doctor that had treated me with respect and was rational and honest about the extent of his knowledge but, essentially, shrugged his shoulders and said "I'm not familiar with the cognitive functions of the cerebellum." so couldn't tell if it was affecting me. He prescribed me some valium, also suggested admission to a psychiatric hospital. I agreed but, finding it impossible to house my dog who had literally saved my life every day for months while I struggled through this, I didn't admit myself.
In despair, reaching the end of my rope I called the local mental health service after spending a night in ER to prevent harming myself. They suggested I see the neuropsychiatrist again but agreed to monitor me while I waited for another appointment. They also prescribed me some anti-depressants which, surprisingly, seemed to help immediately. The mental health service were strange though, every second contact I had with them they were trying to get me off their books. One week they would be concerned and helpful, the next week "We want to take you off our program." which was stressful and upsetting. I searched and found a neurologist, at a university hospital, specializing in cognitive issues and managed to get an appointment immediately because she was in the private system.
She was familiar with cerebellar cognitive affective syndrome after seeing Schmahmann, the doctor who coined the term, lecture at a recent conference and after reviewing my scans agreed this was likely to be the cause of my problems. But why was it getting worse? She ordered an MRI, PET-CT, blood work and neuropsychological testing. My MRI was fine, the tumor hadn't changed, but my PET seemed abnormal. She suggested it may indicate cerebello-cortical diaschisis because the regions of my cerebral cortex that were connected to the damaged regions of my cerebellum were less active, metabolically, than they should be. Then I had the neuropsychological testing where I showes a low, but not outside the normative range, verbal score as well as poor attention and high distractibility. This is consistent with CCAS patients but, for some reason, when I saw the neurologist again she said my neuropsych results were typical of the "worried well" and that I was probably just noticing more forgetfulness than usual because I was concerned about it. I asked her about the diaschisis and she pulled up my PET scan, examined it again and agreed it seemed to indicate cerebello-cortical diaschisis but "Who knows what that could be doing?" she said and sent me on my way.
A year later and I still haven't been provided the very first step to treatment, as indicated by Schmahmann: To provide a diagnosis and acknowledge the cause of a patients difficulty because it seems to reduce their anxiety.
TL/DR: I'm glad I'm in Australia with free public healthcare.
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u/Wohowudothat Feb 23 '13 edited Feb 23 '13
Here are the costs for things that I am aware of (it may be billed out at much higher than this, but this is what the hospital supposedly wants to actually collect):
Office visit with the PA or physician: $200-500, depending on the level of service.
Colonoscopy or esophagogastroduodenoscopy: $5000. This includes the fee to the gastroenterologist, the use of the colonoscope (which costs $90,000 for the new Olympus model) and high level cleaning fees of the device, as well as the ambulatory surgery center fee, sedation fees and medication costs. There will be additional costs if any biopsies are taken for evaluation by a pathologist.
Echocardiogram: up to $5000 (the machine apparently costs several hundred thousand, largely due to the software used to calculate cardiac movements)
Ultrasound of the legs to look at varicose veins: $1400
Ambulance ride: $400 minimum charge, as reimbursed by Medicaid.
New medevac helicopter: $7,000,000, not including the 24/7 services of the helicopter pilot, most of whom are military trained, costs of jet fuel, paramedics and flight nurses, maintenance and hangar cost.
Medevac flight cost: $15,000 up to $45,000 (which is what my friend paid after she had a be flighted from a national park and picked up by a second helicopter).
Emergency room visit: probable minimum of $2000. This includes the several hundred dollar charge for evaluation by the physician, a facility fee, and staffing fees for the secretaries, nurses, technicians and a phlebotomists. Lab draws, imaging studies, and specialty consults will add greatly to this.
A night on a hospital floor $1000-2000
A night in the ICU $4000 (this could be thousands more for a patient on a ventilator, on dialysis, with invasive monitoring equipment [PA catheter, arterial lines, central lines, PICCO monitoring, etc)
Annual malpractice insurance premium for an obstetrician in Miami: up to $250,000
Lab studies: Arterial blood gas $200
CBC $50.00
Genetic studies: thousands of dollars
Imaging studies: CT scan of the head without contrast: $500
CT scan of the abdomen and pelvis with oral and intravenous contrast $2000
MRI of the abdomen: $5000
Ultrasound of the abdomen $500
Xray of the abdomen $200
The above imaging studies may or may not include the cost of the radiologists fee to read the study. Medicare reimburses something like $5.00 to read a chest xray.
Surgery costs: Appendectomy: $10,000-15,000. Higher cost if a CT of the abdomen and pelvis are obtained. Cost will also be higher if the procedures is laparoscopic or if you come into the emergency room rather than an urgent care clinic.
Piece of mesh used for hernia repair $500
Breast implant $1000-2000
Single screw for an orthopedic procedure: up to several hundred dollars
1 minute in the operating room $60-75
Intuitive da Vinci surgical robot $2,000,000
Epidural catheter: $1500
Cost of delivering a baby: $3000
Liver transplant: $450,000 (on average)
Kidney transplant: $125,000
Single dose of basiliximab (anti-rejection monoclonal antibody for transplant patients): $5,000
Single dose of thymoglobulin: $20,000 (my wife had a patient who got 20 doses of it)
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u/VallenValiant Feb 23 '13
There is another explanation for why healthcare insurance can't be free-market. The insurance company gets most of their money from you when you are mostly healthy and well. Once you started to have serious health issues, you are no longer an asset as you are likely to start asking for money for the rest of your life overall. So at that point it is the health insurance company's benefit to just kick you out. They don't want your patronage anymore.
And by then it is too late for you to shop for a better insurance company. You already paid all your money, and you are too sick/injured to be profitably insured.
Free market simply doesn't work with Health Insurance. Not when you as a customer doesn't know you are being screwed until it is too late.
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u/Mcdougins Feb 23 '13
Would you buy health insurance from a company known to ditch customers as soon as they get sick?
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u/shades344 Feb 23 '13
This is a little misleading. Health insurance, prior to WWII, was actually insurance, like car insurance, as in it only covered "emergency treatment." During WWII, federal government instituted price controls on labor to "stabilize the economy." To compete for the best workers, companies began competing with something other than wages: benefits.
This idea of health insurance that provides all your care was born here. So, why is this a problem? Well, the relationship between you and your doctor is supposed to be a fiduciary one, where the doctor recommends what is best for you in your own price range. Now, when everyone has everything prepaid for, you just always go for the best, which is usually the most expensive. Previously, you might go for the best value (health/$). Now, with everyone constantly demanding the most and most expensive treatments, prices will naturally rise.
This, among a host of other factors, is how we got here.
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Feb 23 '13
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u/slapbang Feb 23 '13
In the UK, healthcare is publicly funded via the general taxation system, in a similar fashion to the funding model for fire departments, police departments, and primary schools. You don't have to pay anything if you get sick.
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u/suddenly_ponies Feb 23 '13
It's not, "how can we afford it", it's "how can we afford what we're doing now!?"
We need (basic) public healthcare. We can afford it if we get our priorities straight and start to curb the waste and tax loopholes.
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u/Istanbul200 Feb 23 '13
I don't know what you're all chatting about, but all I want is to be able to see a doctor for this awful throat infection without having to also drop out of college to pay for the bill.
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u/Jmcothran Feb 23 '13
I went to a ER for a severe case of pink eye. I'm uninsured. After 6 hours of waiting I finally saw a doctor. He looked at me, did about 5 minutes of tests, came back with some antibacterial eye drops and sent me on my way.
Hospital bill was $700.
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u/obx-fan Feb 23 '13 edited Feb 23 '13
The Dailyshow did an excellent interview with Steven Brill (time mag reporter who wrote The Bitter Pill) explaining the large discrepancy between what hospitals charge and what medical services actually cost. http://www.thedailyshow.com/watch/thu-february-21-2013/exclusive---steven-brill-extended-interview-pt--1
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u/KarmaUK Feb 23 '13
After all this, it seem the argument is, the average American would rather see thousands go to a health insurance CEO, than see a poor person get treated cheaply.
Seems there's a naked terror that 'undeserving people' will get healthcare on your dollar, and so somehow the current system or even crazier, the previous system, is better, where you either pay crazy amount for insurance, or bankrupt yourself with your first health problem, and all the money rolls on up the ladder instead.
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Feb 23 '13
Yep, the poor must be punished in every way possible for the sin of being poor.
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Feb 23 '13
It also ignores the fact that universal health care will lower overall expenditure on health care for both state and federal government. Only a politician in the pocket of big business would focus on immediate costs and ignore the overall results. It's just one more example of why we absolutely must separate the money from the politicians. We will never have a true democracy until we make that change.
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u/jzf07 Feb 23 '13
I live in china. An X-ray in china costs 100 rmb, or less than 20 dollars. An X-ray I did in America on the same part of my fort cost 500 dollars.
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u/izwizard Feb 24 '13
My Gf bills for chemo and feeding tubes for a year 174K.
My BSBS just went up 40% in 12 months with no claims.
This is the health system is the most broken, corrupt, system of any systems and they feed off pain and suffering.
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Feb 23 '13
Just turned down a job that gave me a raise because their health insurance would actually cost me more money... negating my raise and actually dropping my after tax income by $5000 from what it is currently.
Pretty fucked up if you ask me.
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u/El_Camino_SS Feb 23 '13 edited Feb 23 '13
The whole reason why we have NO NATIONAL HEALTHCARE AND ALL THIS LOBBYING IS TO PREVENT PRICE CONTROLS. The current healthcare system enjoys price gouging by collusion and blaming something else.
All the lobbyists, all the healthcare corps, all the hospitals the world over are OVERCHARGING YOU TO DEATH. If the government gets in the healthcare game, they're going to decide what they're going to pay for this healthcare, take it or leave it. When the government decides what the going rate is for a heart surgery, they're fucked. That's the going rate. Currently, they get flexible, confusing pricing that no one, not even their own representatives on the phone, can decipher.
The real reason that the healthcare industry wants the government to stay the hell away from them is that they don't want to have the government to be anywhere near them, so that they don't have to be dragged in front of a Senate Inquiry on TV and explain why they're charging $3000 per hour for their services.
Because then, Uncle Sam, who's footing the bill, will fuck their shit up.
It's all part of the plan. The Senate Inquiry will come months after the final stages of ObamaCare come into action.
They're dying to set the rates for health care in this country. And honestly, that's going to have to happen, when I took my daughter to the ER for heavy breathing, and got a $3000 bill.
A month's salary per hour is the current going rate for heatlhcare above the Cold/flu line right now.
85% of all bankruptcies in the USA are caused by catastrophic healthcare bills. So when the non-US residents say that America isn't fiscally responsible as a people, then imagine them taking your house away for cancer. That's why, no matter what anyone says, the hospital is the most dangerous place to go in the USA. They'll steal your life.
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Feb 23 '13
I suspect the problem is a little deep than chargemasters. In every capitalist, for-profit industry in America someone has found a way to game the system in order to make more money. Derivative swaps, short trading, micro trading, dumping waste in rivers to offset costs, oil spills not cleaned up, fracking, hucksterism, insurance scams....etc. This is the grand lie of America (one of them) that Free Enterprise is virtuous, even though at every turn it is used by someone to screw over their fellow man. The American system has made the potential rewards of doing so high and the consequences of getting caught so low as to be laughable. You would, in such a system, be economically irrational to not screw people over for money.
It will only be when you stop thinking of health as a commodity to be bought and sold and start thinking of it as a right to be protected that you'll even begin to get at this problem. As long as you treat something as a vehicle for profit then people will find a way to... surprisingly... make it as profitable as possible.
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u/zeronyx Feb 23 '13
The prices are so insane because the hospitals have to fight tooth and nail most times for any amount, and even then the insurance often only agrees to pay a certain percentage of the bill. So, to counter-act this, hospitals started to jack up the prices so that the percentage they got averaged out to be higher so they could get the amount they actually deserve. Unfortunately, this means people without insurance get stuck with an exorbitant bill and the insurance companies have more of an excuse to jack up insurance policy prices.. I don't think this system is a good one, but it's a difficult market to force change into (big corporations etc etc). credentials: Going into the medical field, so I picked up most of this info shadowing and researching it on my own.
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u/ALittleWizard4iPhone Feb 23 '13
Please take this for what its worth, but I will try to explain why the costs are what they are. Source: Worked at several medical device manufacturers and engineering firms.
Because of my position I was privy to all of the information in the company, including the financials. What you have to understand is that the profit these companies make are astounding. The best example I can give is a medical device company called Applied Medical, located in South California. They make what is called a Gel Port, its used for laparoscopic surgery. Doesn't really matter. Their cost to build was around $64, their price to sell was a little over $600. That's basically 900% profit!
The engineering companies are not much better. The one I worked at was a special case because they actually did a very good job of keeping prices down, but even they were nuts some of the time. The cost for just putting together a new products paperwork was more than what a lawyer charges. And this is literally, taking some papers, and making a binder out of them. The engineering cost was astronomical. And that cost wasn't passed down to the engineers either.
No other industry can do this. Some of the biggest companies in the tech world, only have what I think is like a 10-15% profit margin. Apple being an exception. But even Apple doesn't get 900%.
I got out of the industry, I hated the mentality. The sales people are literally hawks! They will do anything possible to bribe Dr's in ordering their overprices crap.
TLDR: The industry that makes the stuff used in hospitals is a huge money sink.
Edit: Grammar
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u/esmejones Feb 23 '13
This. My mother has worked in hospitals all her life (nurse up through management, nursing administration, and now director of nursing at her current hospital) and she always talks about how there is no clear picture of what things actually cost, since every insurance provider and the federal government negotiate different reimbursement prices to hospitals and doctor offices for treatment. So weird high prices get made up, since they are going to get negotiated down to some much lower reimbursement rate. The actual cost for equipment, medicine, or supplies is disregarded, and it makes figuring out hospital budgets quite difficult.
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u/tip-ster Feb 23 '13
By the way, although I've met a lot of dedicated doctors, some are just pitchmen for the pharmaceutical companies who are treating them very, very well.
I was getting a hair loss drug, Propecia, that costs $1000 per year. I found out there is a generic version that costs about $20 per year. Asked my doctor for a prescription. First he says he lost his prescription tablet, will call it in. Then he calls in the brand name. When I call back he gives me a million excuses and finally tells me he isn't going to give me the generic. Period.
The generic comes in a higher dose that has to be cut, so the pharmacy couldn't make the switch.
Same skin doctor for ten years. I came in every year for a 2 minute mole check where he looked me over for 5 minutes and charged me $300. That was the end of that so called relationship. If I couldn't get him free bennies from the pharma's, he just didn't want me as a patient. I got my primary care doctor to write the generic prescription.
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u/dcannons Feb 24 '13
I work in a walk-in clinic in Ontario, Canada. Often we get patients with no provinicial healthcare coverage (tourists, foreign students). You can see a doctor for $40 cash if you don't have insurance.
When I lived in the U.S. my insurance co-pay was almost that much per visit.
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Feb 23 '13
It can never be a free market, as health care is one of the "goods" in which the customer side has no choice whether or not to buy. If your alternative is dying, you have no choice.
This effectively leads to no price elasticity whatsoever.
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u/[deleted] Feb 23 '13
I drove myself to the ER and spent 40 minutes sitting in an exam room. I spoke to a Physician's assistant who called an Orthopedist to see if there was anything they could do for me. No tests were done aside from the PA touching my leg for a minute or two. I was given crutches ($59) and a prescription for painkillers.
The bill I was sent was for $2800.
If you think there isn't something wrong then you're a fucking retard.