Calling a 'spade' a 'spade'...

[Bruzilla]

The reason that healthcare is so expensive is because we are such utterly pathetic consumers of it. Ask someone about where the best deals on milk, gasoline, or a pair of Nikes is and they'll usually be able to give you an answer right off the top of their heads. Ask someone who provides the best open-heart surgery for the lowest cost and they'll be unable to answer. Ask someone how much it costs them to get a common physical and they'll probably cite you what their co-pay is and have no idea what their insurance company is getting charged. We don't shop around for the best deal in medical care like we shop around for everything else because we're conditioned to paying a premium plus a co-pay and we have no incentive to look for a better deal. And providers take advantage of that ignorance by charging the maximum that any insurer will allow without regards to what the actual cost of treatment is.

I remember when my son broke out the rear window of my car and I went to glass place in the park for a replacement. The intitial price quote was $350, which I said was way too high for me to pay. The guy then asked if I had glass coverage, and when I said no and told him I was paying out of pocket, the price dropped to $90. I guarantee you that if fewer people had insurance you would see the price of healthcare dropping dramatically as providers competed for out of pocket money. Adding more people to the insurance roles only drives costs up.

 

[Larry Gude]

Bruz...

...I agree with what you're saying but there is still a role for insurance.

For everyone; The entore idea behind insurance is to cover what you cannot cover yourself, or at least can't cover without more financial discomfort than you, the insured, decide upon.

That's why catostrophic plans are attractive. You pay for all the 'little' stuff, providng the motivation for thrift and you're well covered if something major, say more than $10,000, happens.

 

[SamSpade]

The reason that healthcare is so expensive is because we are such utterly pathetic consumers of it. Ask someone about where the best deals on milk, gasoline, or a pair of Nikes is and they'll usually be able to give you an answer right off the top of their heads. Ask someone who provides the best open-heart surgery for the lowest cost and they'll be unable to answer.

Thing is, the doctor experience and the glass specialist experience is different. To see my doctor about back pain, I call for an appointment. I go a few days later, ON TIME, pay my co-pay to the receptionist, and wait for 45 minutes UNTIL I get called into the "little room", where I wait another 20 minutes for the good doctor to show up - and do his best to diagnose the situation. Not wanting to make a *mistake*, he orders a bunch of tests, some of which will prove unnecessary. He'll then give a referral and schedule a follow-up - at which point I'll FINALLY have some idea how much this is going to cost me.

IF I'm *stupid* enough to try to take this to ANOTHER doctor, he's gonna want copies of my entire medical history, schedule a couple appointments and make me fill out a pile of *paperwork* (yep, even in this day and age).

If I go to the glass specialist, I will talk to the guy who will actually DO THE WORK inside of five to ten minutes of just walking through the door. He knows more or less EXACTLY how much it will cost.

I *did* do this sort of thing when it came to removing a tree from my property - scheduled four appointments, got estimates on the work needed, and picked one. In the time it would have taken for me to see my doctor the first time, I'd seen all the estimates and the tree was already gone.

The PROBLEM about comparison shopping with doctors is, the health industry is set up on the assumption that you're insured, and the cost is irrelevant. The only reason you need a second opinion is the diagnosis - the COST doesn't come into play, 'cause you ain't payin' it.

I'm not sure how I'd like this - I mean, it'd be great if doctor's fees were competitive - but it's like that story about astronauts flying to the moon on a machine built by the *lowest* bidder - NOT a comforting thought. I'd hate to see a day where doctors could say "I can operate on *your* heart in three notes!" (a la "Name That Tune").

 

[Bruzilla]

I think that you'll find that the doctor who charges less for a physcial will charge less for everything else as well, so you should only need to shop around once. But that's a moot point anyway as the problem isn't with "you" shopping, it is with the nation as a whole. People are conditioned to just go to a doctor and pay whatever you have to pay, and until that general mindset is changed, no good will come.

As for the quality vs price issue, are malpractice lawsuits limited to the lowest-cost providers, or do a lot of high-price doctors find themselves getting sued as well? I've seen no evidence that really shows a definative correlation between cost and quality of service for healthcare providers. Costs are largely determined by overhead costs. Many providers look at gaining a seat at a hospital much in the same way as a clothing seller wants to move from a strip mall to a shopping mall. Their quality of product may not increase, but the perception of quality changes. That's why so many doctors will try to get positions at every hospital in the area. This drives their costs up, but the quality of service is still the same... it is only the perception of quality that changes.

I think the best example of the point I am trying to make is laser/lasik eye surgery. This is one of the rare examples of a medical practice that has evolved almost completely outside the influences of insurance as most plans do not cover it. When laser eye surgery first came out, you were looking at paying $5,000 or more per eye to get the procedure. And, the quality of service was not that good as the process was still being developed. Now a days you can get top-grade service, using state-of-the-art equipment, for less than $2,000 for both eyes. So we've seen quality go up, and prices come down. Why? Because there were no deep-pockets paying the bills. If the providers charge too much, the patients won't come as the money is coming out of their own pockets, so they have to price accordingly. Also, since costs are a driving factor, and consumers are price shopping, providers are driven to constantly improve their service in order to remain competitive. Where else has this happened in the medical community? Only in areas that insurance plans usually do not cover.

 

[itsbob]

According to Nagin.. it's chocolate..

 

[Larry Gude]

Eye surgery...

...is vanity, IE un-necessary work and, yes, it is outside the giant insurance/provider/lawyer triumvirite.

You sign off; This might make you go blind.

No insurance company is on the hook with no assets to protect; just you, who have already decided you are willing to go blind, with no repurcusions, if something goes wrong.

Again, one insures what one judges he can't afford to pay for on his own.

I don't care how many middlemen are eliminated, you're not going to get open heart surgery or kidney dialysis or muliple major injury car accidents down to a few grand.

 

[Bruzilla]

Larry... dost thou forget that it wasn't so many years ago that open heart surgery did cost "a few grand?" Maybe not as cheap as Lasik is today, but back BEFORE it was an accepted practice it was much, much cheaper than it is now even after taking into account inflation.

BTW, you completely missed my point on the eye surgery. I was in no way arguing that any insurance plan should cover it. It is elective vanity surgery and needn't be covered... but that wasn't my point. My point was and is that this medical prodecure has evolved over the past few years pretty much devoid of any insurance payments and the result has been innovation, improvement, AND lower costs. I challenge you to point out one other form of medical treatment, that's typically covered by insurance plans, that has gone down in price during that period. Find just one... and good luck 'cause I just finished working on the Blue Cross Blue Shield Medical Infomatics effort that was tasked to identify and track prices throughout the industry and I can tell you there ain't any that have even maintained costs yet alone shown even a small reduction... or the 50%+ reduction that Lasik has shown.

The reason that these costs keep going up is because what choice do we have? Since medical insurance became a pre-requisite of most employees, the providers can charge whatever they can get away with from the insurance companies, and the insurance companies will make up those ever increasing costs by upping the insurance premiums and reducing coverages every year, and you and I get stuck paying the bill. I'm not advocating you to drop your insurance as there is no plan B here, I'm just pointing out that when you talk about the high cost of medical care it isn't due to regulation, lawsuits, R&D, doctor shortages, etc., it's about the fact that there are ZERO checks on the increase in prices due to insurance and consumer apathy.

 

[Larry Gude]

Damn internet...

BTW, you completely missed my point on the eye surgery. I was in no way arguing that any insurance plan should cover it. It is elective vanity surgery and needn't be covered... but that wasn't my point. My point was and is that this medical prodecure has evolved over the past few years pretty much devoid of any insurance payments and the result has been innovation, improvement, AND lower costs

No, I got that and I agree with your point 100% insofar that elective eye surgery has reached the point, totally through FREE market forces. We're on the same page there. I can see where that would, not could, but would be the case if insurance disappeared tomorrow. But at what cost?

I challenge you to point out one other form of medical treatment, that's typically covered by insurance plans, that has gone down in price during that period. Find just one

There are some things, MTI's, CAT (now CT) scans and some other tests and procedures that actually have become cheaper over time. Much of the reason was market driven as well; a group of docs would by an MRI machine for a million bucks or whatever and want that puppy being used.

There are also major procedures now using lasers and ultrasound as alternatives to old fashioned surgery that are cheaper, sometimes safer or simply a better choice.

There's more than one but we still agree, by and large. Having Carefirst I've seen offices cut the price on all sorts of things because, I guess, CF is only gonna pay so much, they know it and they're cutting me some slack.

I'm just pointing out that when you talk about the high cost of medical care it isn't due to regulation, lawsuits, R&D, doctor shortages, etc., it's about the fact that there are ZERO checks on the increase in prices due to insurance and consumer apathy.

Yes, there is checks and balances; The lawyers, drug companies, doctors and insurers are all in the same business and they all want to get paid. They form a mutual support society.

The Foxes are watching the hen house.

The bottom line, I think, is that this 'medical industrial complex', if you will, does some amazing things and the net result is that healthy people live even healthier than before. Unhealthy people live healthier than before and people who ought to be dead are living longer. BUT IT COSTS MONEY.

I'll allow everyone to weigh the value of that for themselves because for sure too many people are simply giving their lives over to doctors and not even trying to take care. In my recent journey to get my shoulder fixed and my sleep breathing fixed I've seen an awful lot of people who, frankly, ought to be dead and Lord knows how much their treatments are adding to the mix.

For my arm, my doc got her piece by looking at it and saying, "Yep, looks like your shoulder hurts. Go see these guys."

Those guys got a piece by staing "In my professional medical opinion, your shoulder hurts like a mofo. Go see these guys and these guys and get back to me."

The MRI people couldn't care less what hurt, they got a piece by taking the pictures.

The physical therapy people said "Wow, I can tell that hurts." and got their piece.

Now, to that point, the PT people beat the crap out of me and they are the only ones who made me feel better.

Then, the MRI, back to second doc. "Looks like you shoulder is MUCH better, huh? Them good old PT people...Anyway, the MRI shows a bunch of fluid. Keep doing the exercises. Don't go back to PT. They showed you how to do the exercises, just do them. I see no point in me cutting you now. As long as PT is dong the trick, there you go. Looks like an old tear, so, maybe you come back in a year or two, maybe never. You decide how much life it's costing you. Bye!"

So, a whole bunch of people got a piece and my shoulder didn't need surgery. Maybe 20 years ago, who knows? Cheap but un-necessary surgery that maybe don't come out to good?

I think my plan, (the Bush/xyelot) of everyone paying for their own insurance, would basically work the way you see thigns because an awful lot of people are going to spend less on insurance when they're writing the checks.

That will put pressure on prices.

 

[Bruzilla]

Your hearts & violins view of the medical industrial complex is compelling but hardly realistic. The fact that the medical community extends lives or fixed yer' shoulder isn't really relevent to the discussion. Neither effort is what's driving prices up.

Here is something that I find relevent: In 2004, medical insurance companies reaped somewhere in the neighborhood of $12,000,000,000 in profits. That's not costs... that's profits. Assuming that most like to work at about a 20% profit margin like BCBSFL does, that would make net revenues at $60 billion dollars. That's 60 billion bucks to do nothing more than take money from your wallet and put it into a provider's wallet, nothing more. They didn't fix any shoulders, they didn't extend any lives, all they did was pass through $60 billion dollars and in the process made $12 billion. Think about those numbers for a moment as they are quite striking. BCBSFL alone made over $229 million in profits alone last year. How many people would get patched up using just that $229 million, yet alone $12 million, and how many of us could get treated for much, MUCH, less by paying for treatment at point of service rather than through insurance companies? Is there any element of the medical industrial complex that sucks up that much money and yields no treatment, medication, R&D, etc? I think not. So is your sense of well being worth $60,000,000,000.00? Only you can answer that question.

So... why are we paying that $60 billion bucks? Because there are no real checks and balances on the system, and that's for the most part because of views like yours. People look at healthcare and say things like it's all for the greater good, how can you skimp on paying for healthcare, I only want the best when it comes to my healthcare, etc., and the medical community uses those views to gouge us. Like Rush Limbaugh once said, "if we all had hotel insurance, nobody would ever stay at a Motel 6 again" and that's the truth.

Imagine if there was no health insurance and everyone had to pay out of pocket with our meager paychecks. Would doctors still be able to charge $100 for a 10-minute office visit, or would people either stop/postpone visits or shop around for someone charging less, thus putting the $100 doc out of business? Would hospitals be able to charge $40 for a Tylenol, or would they have to lower their costs to a realistic figure because people would demand they do so or go elsewhere? You could make the argument that they would just say "if you don't want to feel pain... pay the $40 and shutup", but that attitude wouldn't lead to very much repeat business or word-of-mouth business, and again... people would start to shop around more for someone only charging .50 for a Tylenol. We allow these outrageous and ever growing costs because "we" think we're not really paying them... the insurance company is paying them. And whenever the providers raise their rates, as they often do, then the insurance outfits just raise their rates, and we pay it because we're too chickenpoop to say enough is enough. And if some politician has the nads to stand up and say that enough is enough, he/she gets beat down with arguments like how dare you put a price tag on my healthcare requirements!