In reply to BrokenYugo:
I said perceived costs. Real costs would likely go down but erma gerd it would mean higher taxes that no one wants to vote for most likely since we probably wouldn't attempt a full blown rethink of tax policy
In reply to BrokenYugo:
I said perceived costs. Real costs would likely go down but erma gerd it would mean higher taxes that no one wants to vote for most likely since we probably wouldn't attempt a full blown rethink of tax policy
This is a very complicated situation and it's not made better by the insurance companies. They make BILLIONS of dollars in profits a year. Their executives made millions and millions.
The paperwork that the insurance companies make us providers do is ridiculous, makes us have to hire people just to handle it.
The hospital administration corp has ballooned because of it. MBA's now run hospitals and they make MILLIONS of dollars.
Believe me, the doctors are a tiny cog in that system and comparatively very poorly paid considering the school time invested.
In reply to docwyte:
I agree. The administrative costs have gotten out of hand, which is due to both regulation and insurance issues. I actually have a bill sitting on my desk from the hospital my son was delivered in for $780 for just administrative costs (just for him I paid my wifes already) from December 2016. Mind you they can't seem to figure out how to submit it to the insurance company (this is the third time I've had to go back to them and tell them I don't pay anything without seeing an EOB first) and I'm likely not going to pay that much, but that's kind of absurd.
Doctors obviously need to be compensated for their services but I'm not sure we need so much bureaucracy in between them and me.
thedanimal wrote: My appendix exploded earlier this month, after surgery, 5 days in the hospital and a Catscan my bill was $75K. Thankfully I have good insurance and my out of pocket will cost around $1900. I can't imagine not having insurance, I would be living out of a refrigerator box after this situation without insurance.
My wife was in the ER for 5 hours over the weekend of the fourth. Had a cat scan. We received a bill for $4100. Your insurance is better than here's I guess.
thedanimal wrote: My appendix exploded earlier this month, after surgery, 5 days in the hospital and a Catscan my bill was $75K. Thankfully I have good insurance and my out of pocket will cost around $1900. I can't imagine not having insurance, I would be living out of a refrigerator box after this situation without insurance.
For something like 1/2-2/3rd of American households, an unexpected $1900 bill is the first leg of a trip to cardboardtown.
This is why the majority of bankruptcies in the US are due to medical bills.
In reply to Nick (Bo) Comstock: Morbidly amusing tidbit about health care bills. The DO NOT expect anyone to pay amounts like that. They send out absurdly high numbers, wait for a call from the shocked consumer, and immediately offer to accept half (or even less) if you can pay the bill in full right now.
It's worse than a used car lot for "The Haggle".
When my son was born (and had a brief visit to the NICU) the hospital sent us a bill for 5 grand. I think by the time I was done arguing with them, sending it back through insurance a couple of times, and having them discount my portion..... I paid less than a grand OOP.
dropstep wrote: Its a mess for sure. Obamacare has just made it more exspensive.
That is because the regulations closed a lot of loopholes that the insurance companies would abuse in order to take your money and weasel out of paying out. Not all of them, but a lot of them. With fewer avenues to screw over the consumer, the insurance companies had to start to charge more for policies.
The ACA, for all of its warts, did at least do a wonderful job of highlighting a lot of the faults with the medical industry.
Won't go into the political stuff. I work in Oncology, and see the real cost of care.
If she needs Heart and Lung Transplant without insurance, $1M is too low. Might be too low lifetime with insurance. The anti-rejection medications and multiple yearly doctors visits she needs to do lifelong are not cheap.
In oncology we have Immunotherapies now that are game-changers. Some people with stage 4 cancer are going to be living years and maybe decades longer because of them. the drugs themselves - not the care associated with them, just the little vials of drugs - can cost $1M a year alone for a cocktail.
Merck's Keytruda is $150,000 a year. Merck is estimating $1.5 BILLION in sales for that drug alone this year.
If you think healthcare costs are high, you ain't seen nothing yet.
KyAllroad wrote: It's the out-of-control costs.
...which are largely the result of having to treat everybody without regard for ability to pay, which is largely the result of government meddling, which is largely the result of out-of-control costs, which are largely the result of government meddling, repeat ad nauseum.
Meh, screw it. I had a large post under way with lots of math and stuff, but it's useless and probably too political anyway. I'll just summarize with the following bullet points.
I don't have a problem with people and companies making a profit on life-sustaining necessities like food and health care.
We do not currently have a free market healthcare system, and have not had one for 50 years at least.
Subsidies come from somewhere, and that somewhere is not necessarily just within a given country.
There's a LOT more to this, but I'll leave it at that.
docwyte wrote: This is a very complicated situation and it's not made better by the insurance companies. They make BILLIONS of dollars in profits a year.
TRIGGERED
I find people don't recognize the difference between profit and profit margin, and that colors their thinking. It sells a lot of outrage and advertising space to scream about the evil healthcare industry making billions in profit while little Lulu was denied healthcare because she couldn't pay.
$1 billion profit in a trillion-dollar industry is a 0.1% profit margin. Commonly-accepted profit margins for regular industries are in the 10% ballpark, and can of course get much higher than that. Profit margins in the healthcare industry range from about 3% to about 30%, depending upon the sector and level. Is it a lot of money in raw volume? Yes. Is the entire industry made up of Snidely Whiplash robber barons? Not really.
Duke wrote: TRIGGERED I find people don't recognize the difference between *profit* and *profit margin*, and that colors their thinking. It sells a lot of outrage and advertising space to scream about the evil healthcare industry making billions in profit while little Lulu was denied healthcare because she couldn't pay. $10 billion *profit* in a trillion-dollar industry is a 0.1% *profit margin*. Commonly-accepted profit margins for regular industries are in the 10% ballpark, and can of course get much higher than that. Profit margins in the healthcare industry range from about 3% to about 30%, depending upon the sector and level. Is it a lot of money in raw volume? Yes. Is the entire industry made up of Snidely Whiplash robber barons? Not really.
That brings up the subject of advertising, pharma, and profits. Is buying Super Bowl ads about erectile dysfunction and vicodin induced constipation where my prescription dollars should go? Big pharma spends BIG money on adverts and buying doctors rounds of golf. How about if I have an issue in need of medication and your product works, it will sell. Why do I have to "ask my doctor about ..."? I shouldn't be asking my doctor about needed meds. That's his decision based on results, not who buys his office lunch and hands out swag.
The system is sort of geared to screw over the middle class. If you make below a certain amount of money annually, you qualify for Medicaid or other financial aid. If you make above a certain amount of money, you simply pay the bill and go back to your private jet.
The problem is for the Middle Class, who don't qualify for any sort of aid and who can get stuck with bills that are several years' (or more) salaries.
Personally, if I get terminally sick, I'll probably say "berkeley it" and suck-start a shotgun to protect my family from financial ruin. But what if it's your kid? You sure as hell are going to do whatever you can to keep them alive, even if it means you're bankrupt.
Yeah, you're not going to convince me that the Insurance Co's are only making a reasonable profit. Not when they keep trying (and succeeding!) to lower my reimbursement rates, which haven't gone UP since I started practicing!
My costs go up every year! F them, they suck!
Erich wrote: Won't go into the political stuff. I work in Oncology, and see the real cost of care. If she needs Heart and Lung Transplant without insurance, $1M is too low. Might be too low lifetime with insurance. The anti-rejection medications and multiple yearly doctors visits she needs to do lifelong are not cheap. In oncology we have Immunotherapies now that are game-changers. Some people with stage 4 cancer are going to be living years and maybe decades longer because of them. the drugs themselves - not the care associated with them, just the little vials of drugs - can cost $1M a year alone for a cocktail. Merck's Keytruda is $150,000 a year. Merck is estimating $1.5 BILLION in sales for that drug alone this year. If you think healthcare costs are high, you ain't seen nothing yet.
Right here. What can possibly be in those little vials that costs that much? Sure, they pass along the costs of R&D and marketing but unless they contain literal unicorn tears harvested on Mars there is no reasonable way those drugs should cost that much.
To illustrate my point, 17 or so years ago I was taking a nursing class and during a peds portion we were learning about hemophilia. One particularly bad type of which the PhD professor took great delight in telling us that the meds to treat said disease ran about $125,000 per month! Well, at the time my 30 year mortgage was just about that amount so I knew how much 125 large was. I asked "who pays for that?" Her reply: "Well your insurance of course."
Ignoring the fact that insurance pays for nothing, they simply take money in, keep some and dispurse the absolute minimum they have to in order to avoid the mobs with pitchforks. Most policies before the ACA had a lifetime cap of between one and two million. Which would be burned through pretty quick at 125K a month.
So I posed that question, who pays then? Her response? "Well the government of course." Same exact issue as the insurance company only spread across all the taxpayers and not just the customers of one company. Apparently I'm an shiny happy person for even questioning why we pay so much for health care.
I have a feeling there are more Martin Shkrelis out there that have figured out that people will mortgage their futures and even their souls in order to prolong the lives of our sick kids and have gouged accordingly.
What could anyone POSSIBLY do to be worth 377k PER DAY?
Unless they're personally financing the R&D department or harvesting the unicorn tears themselves, it looks like the perfect place to start lowering costs all around.
Because when you put it all into numbers, it really looks like far too much padding all around for what we get.
My apologies if this is the call for the cement truck, but I think I kept the politics out of it.
You can't really have a thread about a political subject on a site that forbids political discussion.
A lot of people say, we could just set up a Canadian style system, but they forget that the demographics in the country are so disparate. For example, we have 10 times the population and at least 100 times as many illegal immigrants. The medicolegal situation is entirely different in the two countries, tort law would have to completely change for it to work, and lawyers make the laws. Good luck getting them to cut their own throats. It is a mess, and it is going to get worse, a lot worse, because that can has gotten kicked down the road for so very long.
BTW, this thread is already way over into the weeds of political discussion, I am out.
Sky_Render wrote: Personally, if I get terminally sick, I'll probably say "berkeley it" and suck-start a shotgun to protect my family from financial ruin. But what if it's your kid? You sure as hell are going to do whatever you can to keep them alive, even if it means you're bankrupt.
I feel the same way about myself. It definitely gets messier with kids. In a way, that was one reason why people had more kids in the old days - there was more of an assumption a few of the ones you had weren't going to make it to adulthood.
Humanity is in a transitional period right now and has been for the last 200 years or so. Making it through this transition won't be easy. And there is no guarantee we'll make it.
Much of drug prices are driven by the R&D costs. Not just for the cost of that particular drug, but also the R&D costs for the multitude of drugs that don't make it to market. I work in that side of the industry and I've seen millions spent on drugs that were never sold. I've watched production facilities get built only to watch the drug it was built for not go into productions - millions in construction costs - down the drain.
And sometimes is not even something that can be blamed on govt regulations - sometimes as a drug goes through the trials, they find out it simply doesn't work.
Often the period of time between when a drug is patented and when it is actually released on the market can be decades. So by the time the drug is ready, they have very little time left on the patent to actually recoup the development costs and make a profit.
When things go right, these companies make billions. But it's a risky business. When things go wrong, thousands lose their jobs. I've watched it happen. Entire corporate campuses that look like ghost towns. Buildings that cost $1B to construct - and then never used - and then torn down.
I wish I had an answer, because it's definitely a flawed system. The only solace I can take is that this flawed system has provided me with a better life than I ever would have expected to have.
Toebra wrote: You can't really have a thread about a political subject on a site that forbids political discussion.
The fact that issue like healthcare and various forms of science have been "politicized" is the real problem. Politics should not have anything to do with it.
Knurled wrote:Toebra wrote: You can't really have a thread about a political subject on a site that forbids political discussion.The fact that issue like healthcare and [...] have been "politicized" is the real problem. Politics should not have anything to do with it.
Why on Earth shouldn't it? It's a basic part of society's most fundamental political question: Who is responsible for providing for the individual?
The sad fact is, the people who make the choices on this stuff don't really represent the vast majority of the populace. Doctors, Nurses, Admins in Hospitals and Insurance Companies, Scientists in Pharma, none of these people benefit like those who make the decisions ie the Politicians, CEOs, Lobbyists, Boards of Directors at the nation's Insurance and Medical companies. This is what baffles the party currently in power, it was far more easy to blame failures on the other party that it was to point the fingers at the highest levels of socio-economic rank. You can't say "we've got to rein in costs, starting with non-medical admin staff and Insurance CEO's first" and not expect to lose donations to next your campaign.
Obamacare, for all it's failings (and it failed hard) did one thing right: it gave lots of people healthcare who will be pissed if its taken away. Hurray for that.
Back to the original point. Since we do live in an ACA timeframe, she can't be denied coverage for her pre-existing condition. She should be able to buy insurance for a few thousand dollars, certainly less than a million.
In reply to jj:
Because thanks to lobbyists and obscure insurance laws, it doesn't have to be.
jj wrote: Why isn't medical service like other industries where companies compete to have the lowest price, and therefor win more customers??
Because in other industries, you can choose to buy nothing with very little side effect. If you get fed up shopping for a cell phone, you can go without it. That's not a realistic option in most cases with medical care. If you break your arm, you can't really choose to forego treatment. If you have chronic pain issues, you're likely to seek treatment at almost any cost. If you have a life threatening illness, you're going to do whatever it takes to fight to remain alive. Therefore, the medical industry is not a true example of a free market. They have people against a wall and everybody knows who has all of the leverage.
I know that I've said it before, but the most logical example that I can come up with to emulate to reform the medical industry would be the utility sector. A long time ago, people decided that utilities were critical to our way of life, and everyone should have reasonable access to them. They're considered a basic need, and are regulated to ensure that they are priced fairly so that the consumer can't be bent over a barrel. Of course actually implementing changes like that would require a massive number of people to willingly cut off their own access to the gravy train and that seems unlikely.
I read an interesting article recently (apologies for not remembering it well enough to link it) that explained that employer-paid health insurance began during WWII. There were government wage freezes, put in place to prevent runaway inflation due to labor shortages. Since employers couldn't offer higher wages to lure workers away from their existing jobs, they began offering benefits, including employer-paid health insurance.
That's how we got out de facto system that still operates today. It's still a sad situation, although it's good that a person is no longer required to have a job with insurance in order to obtain insurance.
It's still a train wreck, and will have to destroy thousands of lives before anything is done about it.
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