Canadian Health Care We So Envy Lies In Ruins

[This_person]

Originally Posted by Bruzilla

Yes, doctors do invest a ton of time and money into their education, but what's the value of that investment? Should it be so the doctor can charge $40 an hour for their services? $400 an hour? $4,000 an hour?

Yes. And the doctor worth $40 charging $4,000 will go out of business. The doctor worth $4,000 charging $40 will be overrun with patients and unable to really help any unless he/she limits the number of patients they'll see. We refer to this as a free market, and (for the most part) it works.

Doctors are free to charge whatever they like and most people don't care because the cost is shared across many people. And when insurers try to get fees more structured, so more people can get service at lower costs to themselves, the doctors threaten to abandon the plan.

And, who wouldn't? The doctor that is worth $4,000 does not want to lower his income. The only doctors I'd expect to be FOR rate structuring would be the $40 doctor whose new rate would be $400. We don't structure the cost of food in general, which is necessary for life. Why would we structure the cost of a service industry?

So, Canada is learning, and hopefully Americans will as well, that it's not insurers that drive costs, it's providers. And as long as most people have this "they deserve as much money as they can make" mindset, the providers will keep hiking the costs and folks will keep paying more and more in premiums or taxes... while the folks who decry any controls on provider incomes will be whining and crying about how their healthcare costs so much.

You pay for what you get. If you want a health care provider who willingly, knowingly could make the same amount of money fixing cars, you pay for what you get. If you want the doctor who got mostly A's in college, you pay for that.

Originally Posted by cwo_ghwebb

Our system is wayyyyy over-regulated. Fully one third of claims never get paid. The biggest cost in our system passes along to the consumer is malpractice insurance costs. The tort system is out of control in the United States, not only in regards to medical malpractice but overall. And since Congress is run by lawyers who get millions in campaign contributions from the trial lawyers, you can figure the odds on getting tort reform.

You state someone has to pay for one to get rich. Sounds like you bought into that economic theory of a zero sum economy which the Socialists push. There is a set amount of money in the pie, and we have to redistribute the pie equally among all the people. If that were true, Bill Gates got more than he deserved, after all the services his company provided weren't worth that much money.

Personally, I'd rather have a doctor tell me the procedure I would need for a problem, than some bean counter.

I beg to differ, but I worked with a health insurer for three years, and I don't know where you're getting this "fully one third of claims never gets paid" nonsense... but that's what it is. Yes there is a lot of regulation, but that doesn't impact claims getting paid, just the amount of compliance efforts like record keeping, data protection, etc. that must also be done. Claim payment is pretty straight forward - you get a covered service by a provider, the claim gets paid.

As to the tort system and malpractice claims, you hear lots of stories about how these are hurting medical professionals, but here's what you don't hear: just like only about 10% of the population commits 95% of the crime, only about 10% of the doctors commit malpractice resulting in claims. The irony of it all is that doctors make their fortunes in large part because of insurers. The doctors can charge as much as they want, and as long as the insurers pay out the patients don't care as they see no financial risk. With malpractice, this gets turned around on the doctors because people who sue do so at no risk to themselves because the lawyer is the one at risk if the lawsuit fails. The doctor's howl at paying higher and higher malpractice insurance premiums, yet have no problem causing higher and higher medical insurance premiums. But even if you did get your tort reform, and even eliminated malpractice suits, the price of healthcare wouldn't go down. Doctors who had been clearing $100,000 after paying $20,000 in malpractice insurance would just say "I deserve to make $120,000 after all those years of paying for all that insurance!" and their rates would not go down.

As to your last remark about a zero-sum game, you are incorrect. Very few providers get their money from patients pockets. They get paid from insurers (self or group) and the government. That money has to come from somewhere, and it gets paid by plan members and tax payers. If the providers want more money for their services, the premium amounts have to go up to get them that money. If doctors in Canada want more money, then the tax dollars needed to pay them have to go up.

It might help you to think of healthcare as a company. The providers are the workers, and the insurers and the government are the financial folks. They have to make sure that there is enough money to make payroll for their employees, which means there's enough money in receiveables (premiums and govt. payments) to meet payroll. Payroll can't go up without receiveables going up. If this were a manufacturing company, they would have to increase the number of products made and sold, or the price of those products. With insurers they have to increase their prices and with the government they have to increase taxes. The more the doctors want to charge, the more the increases have to be as there is no alternate source of funding. So the only way doctors can make as much money as they want is for insurance plan members and tax payers to pony up that money.

Originally Posted by cwo_ghwebb

We would get stupid items on the bill such as 'pregnancy tests' for $165 for an 83 year old woman! When questioned about the bill, the hospital told us it was standard procedure required by insurance companies. Stupid.

And your hospital lied to you. Health insurers do not, repeat do not, set standards of care. Only providers can do that. All the insurers do is determine what will be covered and how much they will pay for it, and the amounts are negotiated between the provider and the insurer. An insurer can not order any tests. The only way that things like tests can be "required" would be if a hospital needs to show a documented reason for a procedure, and I can't think of any procedure for an 83-year old woman that would ever require a pregnancy test.

Your hospital did what a lot of providers do... blame your insurance for some problem and like most people you accept the explanation without question.

[vraiblonde]

Originally Posted by Bruzilla

Nothing wrong with wanting to be rich, but that means that somebody has to pay for you to be rich.

Spoken like a true Socialist.

Nobody pays you to be rich - they pay you for your service or product. There are a million free clinics in this country but only the poor use them. Why? Because they suck.

If you have money, you can buy better things than your less affluent counterparts. So someone pays me for a service, and I pay someone else for their service and everybody makes money. There is nothing wrong with that. If you're good at what you do, you should make more money doing it than some lamer who doesn't work as hard or isn't as smart.

Bruzilla, you really should take your copy of The Communist Manifesto off your bedside table and burn it. It's messing with your mind.

Originally Posted by This_person

Yes. And the doctor worth $40 charging $4,000 will go out of business. The doctor worth $4,000 charging $40 will be overrun with patients and unable to really help any unless he/she limits the number of patients they'll see. We refer to this as a free market, and (for the most part) it works.

It works? Then why are so many people running about whining about why their insurance premiums are so high? It doesn't seem to be working worth a crap to me. What you fail to take into account is most people have no idea what their doctor is charging. One doctor might charge $400 to fix a broken arm, and another might charge $4,000, and the patients don't know the difference. What's the reasonable amount to fix a broken arm? You walk into McDonalds and order a #1 with a coke, and across the country you know that a reasonable cost is about $5. But ask folks what's a reasonable cost for fixing a broken arm and they have no idea. People have their preference for a doctor, and will blindly pay whatever copay is demanded because they have no idea what a reasonable amount is. You could very well be paying a doctor worth $40 an hour $4,000 and you would have no idea. Your insurance picks up 80% plus of the cost, and sometimes your copay is $50 and sometimes it's a $1,000 and you just pay whatever it is without asking.

Two years ago, the insurer I worked for tried to implement a medical infomatics program that would track how much each provider charged for specific services, so we could tell members how they could lower their costs by going to doctors who charged less for their services, and the doctors threatened to break their contracts and leave. The last thing they ever want anyone to know is how much they charge.

Originally Posted by This_person

And, who wouldn't? The doctor that is worth $4,000 does not want to lower his income. The only doctors I'd expect to be FOR rate structuring would be the $40 doctor whose new rate would be $400. We don't structure the cost of food in general, which is necessary for life. Why would we structure the cost of a service industry?

We structure the costs of all foods! Don't you think the fine folks at Coca-Cola would love to get $100 a bottle? Don't you think the Tombstone folks would love to sell their pizza at $400? But they can't. Why? Because consumers know that a bottle of coke is worth about $1 and a Tombstone pizza is worth about $5. But what is an hour of a doctor's time worth? You don't know as there is no value assigned to it, so it's worth whatever a doctor wants to charge.

Originally Posted by This_person

You pay for what you get. If you want a health care provider who willingly, knowingly could make the same amount of money fixing cars, you pay for what you get. If you want the doctor who got mostly A's in college, you pay for that.

No... you don't pay for what you get... other people do! I get such a kick from people with this view! "How dare you put a price on my healthcare!" Really? So you have the highest price insurance plan that covers everything and costs about $1,500 plus a month? You have all these folks demanding the best healthcare, and that no expense should be spared, but when it comes time for them to pay into the system they want the lowest premium or taxes they can get. It sure would be nice if the people who want to pay the lowest amount into the system would get the lowest standard of service, but it never works that way. They want to pay in the least, and get the best.

How many of you folks who think doctors deserve to make the most money possible have top-tier health plans? Answer: NONE. Like everyone else you bought the cheapest plan possible that met your level of risk. The "money is no problem" discussion only comes into play when it's other people's money you're using to "get what you pay for".

Originally Posted by vraiblonde

Spoken like a true Socialist.

Nobody pays you to be rich - they pay you for your service or product. There are a million free clinics in this country but only the poor use them. Why? Because they suck.

If you have money, you can buy better things than your less affluent counterparts. So someone pays me for a service, and I pay someone else for their service and everybody makes money. There is nothing wrong with that. If you're good at what you do, you should make more money doing it than some lamer who doesn't work as hard or isn't as smart.

Bruzilla, you really should take your copy of The Communist Manifesto off your bedside table and burn it. It's messing with your mind.

Why do you love to equate wanting to pay a fair price for something with Socialism? If your favorite beverage maker came out and said "Hey Vrai, we have a lot of costs to deal with, so we'll need you to pay $100 a bottle for our product" you wouldn't pay it. You would say screw their income, I'll drink something else as $100 a bottle is an outrageous price! But when it comes to healthcare, you blindly hand over what ever amount the provider demands without thought. You have no clue that an equally-skilled provider charges half as much, you just say "Yes... I'll pay it". Me, I want to pay a fair price for a service, and not stupidly waste my money paying two, three, four, etc. times what it's worth. That's not socialism... just common sense. Hmmm... I take it back. You probably would go ahead and pay the $100 a bottle for your drink as you would be too concerned with Socialism in the soft drink industry.

I guarantee you that if you and everyone else had to pay 100% of your healthcare costs out of your own pocket, you would know exactly who charged what for every service you purchased. You would know that nice Doctor A charges $100 for a service that nice Doctor B charges $200 for, and you would go to see nice Doctor A and nice Doctor B would have to lower his costs to compete. But with healthcare we don't have that. All you know is you like nice Doctor B, and you go to him while being totally clueless as to how much he is charging. This mentality is what has allowed doctors to always up their charges, and since most of the money comes from shared risk, either insurers or the government, folks like you are oblivious to it.

[vraiblonde]

Originally Posted by Bruzilla

Why do you love to equate wanting to pay a fair price for something with Socialism?

What is your idea a "fair price"? From each according to his ability, to each according to his need?

Just because you think the government should own everything and set all the prices doesn't mean it's right. Go friggin' live in Cuba or China if you love government control so much. I can tell you right now that if you owned your own business, you wouldn't want the government dictating what you sell your product for and how much money you are allowed to make.

And something else you miss, dear, is that if there were no wealthy people, there would be no tax dollars going into your precious social programs. Where do you think the money for "free" health care is going to come from, anyway?

[This_person]

Originally Posted by Bruzilla

It works? Then why are so many people running about whining about why their insurance premiums are so high?

Because people like to complain. People don't care what things are worth, only what they cost. And, if someone else is getting paid more money (because they're worth it), they get upset that those people are "ripping them off".

Insurance premiums for health care are high. There's no doubt about that. Find a cheaper doctor. If everyone did that, the premiums would drop. Hospitals only charge an arm and a leg to people, not insurance groups. Read your statement one time, and you'll see things like "Charge, 3 gazzilion dollars. Allowed amount, 50 bucks. Provider accepts allowed amount". The insurance doesn't pay what's charged, they pay what they'll allow, and the vast majority of providers accept whatever is allowed - thus the insurance companies ARE setting the price, overall. If most people would find doctors that charge LESS than the allowed amounts, the allowed amounts would drop, premiums would drop, etc., etc.

It doesn't seem to be working worth a crap to me. What you fail to take into account is most people have no idea what their doctor is charging. One doctor might charge $400 to fix a broken arm, and another might charge $4,000, and the patients don't know the difference. What's the reasonable amount to fix a broken arm?

Ask what your insurance will allow, and you'll find out the reasonable amount. That is, (if you're on an HMO) you can get the referral from the right doctor (at no cost to you, or the insurance company, but takes up the doctor's time and his/her staff time) to a doctor the insurance company will accept.

You walk into McDonalds and order a #1 with a coke, and across the country you know that a reasonable cost is about $5. But ask folks what's a reasonable cost for fixing a broken arm and they have no idea.

I think that's the difference between a consistent, and often used product vs. an inconsistent problem people (hopefully) rarely have to use. Do you know how much a cement truck water pump costs? I'll presume not, but you probably have a good idea what to expect to pay for your car's headlight. See what I mean?

People have their preference for a doctor, and will blindly pay whatever copay is demanded because they have no idea what a reasonable amount is.

WHY do they have their preference? Are all doctors the same?

You could very well be paying a doctor worth $40 an hour $4,000 and you would have no idea.

They either help you, or they don't. They either answer your questions and provide you with care that makes you better, or they don't. Most people have a fairly good idea if they're seeing a decent doctor or not.

Your insurance picks up 80% plus of the cost, and sometimes your copay is $50 and sometimes it's a $1,000 and you just pay whatever it is without asking.

For the three people left out there that still do this, stop it. It's dumb.

And, insurance does NOT pick up 80% of the cost. They pick up the percentage of what they think it's reasonable to cost, and often either you or the doctor eat the rest.

We structure the costs of all foods! Don't you think the fine folks at Coca-Cola would love to get $100 a bottle? Don't you think the Tombstone folks would love to sell their pizza at $400? But they can't. Why? Because consumers know that a bottle of coke is worth about $1 and a Tombstone pizza is worth about $5. But what is an hour of a doctor's time worth? You don't know as there is no value assigned to it, so it's worth whatever a doctor wants to charge.

And, if it's too much, the insurance company will not have them "in-network". Or, the doctor will accept whatever the insurance company provides, or the doctor will eat the difference. A bottle of soda is a bottle of soda, for the most part. However, you can pay enormous sums for "boutique" sodas, or you can pay a lot less for generic sodas. Percentage wise, you're probably talking a similar difference in costs. A Tombstone may be worth about $5, but a Ledo's is more than twice that. Go to "little Italy" in Baltimore, and you'll pay many times that. More often than not it's because it's worth it.

No... you don't pay for what you get... other people do! I get such a kick from people with this view! "How dare you put a price on my healthcare!" Really? So you have the highest price insurance plan that covers everything and costs about $1,500 plus a month? You have all these folks demanding the best healthcare, and that no expense should be spared, but when it comes time for them to pay into the system they want the lowest premium or taxes they can get. It sure would be nice if the people who want to pay the lowest amount into the system would get the lowest standard of service, but it never works that way. They want to pay in the least, and get the best.

Uh, thanks for making my point, that you pay for what you get? Actually, yes, I have about the best plan I can afford, the best plan offered to me. And, it's worth it.

How many of you folks who think doctors deserve to make the most money possible have top-tier health plans? Answer: NONE. Like everyone else you bought the cheapest plan possible that met your level of risk. The "money is no problem" discussion only comes into play when it's other people's money you're using to "get what you pay for".

No, not true at all. I pay for the best plan so that I can get the best service, in the manner I want. You get what you pay for.

[chernmax]

Originally Posted by vraiblonde

What is your idea a "fair price"? From each according to his ability, to each according to his need?

Just because you think the government should own everything and set all the prices doesn't mean it's right. Go friggin' live in Cuba or China if you love government control so much. I can tell you right now that if you owned your own business, you wouldn't want the government dictating what you sell your product for and how much money you are allowed to make.

And something else you miss, dear, is that if there were no wealthy people, there would be no tax dollars going into your precious social programs. Where do you think the money for "free" health care is going to come from, anyway?

Bruzllia has woken the sleeping Dragon...

When Bruzilla was in the Navy, he achieved the highest rank of a person that was still told what to think and do, why should things change now. OK going to my room now...

[cwo_ghwebb]

Originally Posted by Bruzilla

I beg to differ, but I worked with a health insurer for three years, and I don't know where you're getting this "fully one third of claims never gets paid" nonsense... but that's what it is. Yes there is a lot of regulation, but that doesn't impact claims getting paid, just the amount of compliance efforts like record keeping, data protection, etc. that must also be done. Claim payment is pretty straight forward - you get a covered service by a provider, the claim gets paid.

As to the tort system and malpractice claims, you hear lots of stories about how these are hurting medical professionals, but here's what you don't hear: just like only about 10% of the population commits 95% of the crime, only about 10% of the doctors commit malpractice resulting in claims. The irony of it all is that doctors make their fortunes in large part because of insurers. The doctors can charge as much as they want, and as long as the insurers pay out the patients don't care as they see no financial risk. With malpractice, this gets turned around on the doctors because people who sue do so at no risk to themselves because the lawyer is the one at risk if the lawsuit fails. The doctor's howl at paying higher and higher malpractice insurance premiums, yet have no problem causing higher and higher medical insurance premiums. But even if you did get your tort reform, and even eliminated malpractice suits, the price of healthcare wouldn't go down. Doctors who had been clearing $100,000 after paying $20,000 in malpractice insurance would just say "I deserve to make $120,000 after all those years of paying for all that insurance!" and their rates would not go down.

As to your last remark about a zero-sum game, you are incorrect. Very few providers get their money from patients pockets. They get paid from insurers (self or group) and the government. That money has to come from somewhere, and it gets paid by plan members and tax payers. If the providers want more money for their services, the premium amounts have to go up to get them that money. If doctors in Canada want more money, then the tax dollars needed to pay them have to go up.

It might help you to think of healthcare as a company. The providers are the workers, and the insurers and the government are the financial folks. They have to make sure that there is enough money to make payroll for their employees, which means there's enough money in receiveables (premiums and govt. payments) to meet payroll. Payroll can't go up without receiveables going up. If this were a manufacturing company, they would have to increase the number of products made and sold, or the price of those products. With insurers they have to increase their prices and with the government they have to increase taxes. The more the doctors want to charge, the more the increases have to be as there is no alternate source of funding. So the only way doctors can make as much money as they want is for insurance plan members and tax payers to pony up that money.

Bru, my wife was HR Director of Southern Maryland Hospital for awhile. When she got cancer, she was HR Director for All American Ambulance, who had 17 medical billers. I have done network troubleshooting for both companies and several doctors over at Pembrooke Medical Center in Waldorf. I stand by my statement that fully one third of claims do NOT get paid. Check the Maryland Judiciary Case search and type in Civista if you think I'm kidding.

I never claimed over regulation was the cause of these claims not getting paid. What over regulation does cause is overhead trying to comply with HIPPA, etc. Your statement regarding doctors charge as much as they want is true, but that's not what they get paid. And I've yet had a doctor tell me our insurances aren't good enough and come after us for the balance of what he/she thinks they should have been paid. Your statement "The doctor's howl at paying higher and higher malpractice insurance premiums, yet have no problem causing higher and higher medical insurance premiums", isn't that at odds with your statement "only about 10% of the doctors commit malpractice resulting in claims"? One would think those 10% would be cleaned up by now. However, as you stated, only 10% of malpractice claims are successful. What is the percentage of nuisance claims by ambulance chasers that result in out-of-court settlements?

The zero-sum game statement is not about doctors in general, but about macro-economics. You seem to proscribe to that socialist thought, there is "X" amount of currency in the economy so the government has to ensure it's distributed fairly, in accordance with that fuzzy thinking called 'social justice'.

"If the providers want more money for their services, the premium amounts have to go up to get them that money. If doctors in Canada want more money, then the tax dollars needed to pay them have to go up." It's not the doctors who want more money, the system is overloaded. Like Mensa says, if something is free, folks flock to take advantage. You don't find many specialists in Canada, because there is no money. OB/GYNs are in critical demand, and just not enough are available in their system.

Maybe you wouldn't dispute items on an invoice, but we sure do. The insurance companies are sick of hearing from us I'm sure. And so are the doctors who charges we dispute. I don't believe a thing the insurance companies say, nor the doctors. I let them hash it out. But they know we do carefully analyze our statements. And way too many times the insurance company has said that certain tests are required so don't give me that b.s. line about insurance companies not dictating care. An informed consumer is the best customer!

Get informed and quit being so envious of those that have busted their butts to get where they are.