US Medical question

In reply to Javelin:

TriCare is not special.

$60 per month IS NOT covering the costs of your premiums. Someone else is footing the bill. TriCare's good customers, US taxpayers, US military (oh, wait... that's the US taxpayers...), etc.

Appointing TriCare (or someone like them) to negotiate the costs does not solve the problem.

Ian F wrote: In reply to docwyte: I understand drug prices are cost-controlled in many countries. I sometimes wonder if we in the US aren't by default subsidizing some/most of that.

Huh, ya think?

As I understand it, defensive medicine, malpractice insurance, and Tort reform is a very small slice of the pie, about 2.5% of total healthcare expenditure in the US.

The average student loan debt of a graduating physician was $183,000. Seems like a lot but in my experience it doesn't really make a huge difference long term. Once out of their residencies and fellowships, physicians make a good living. Hospitalists make $200k a year starting out, and specialists go way up from there.

So while med school loans sound ridiculous out of context, compared to the yearly salaries most physicians are able to secure, they end up being quite affordable.

I think most of the cost in the system is due to increased drug and medical equipment prices. I haven't seen any legislation that touches that, pre or post ACA.

It would be interesting to see somebody draw up a pie chart of just what percent of the money goes where. How much the doctor keeps, how much goes to things like administration, malpractice insurance, buying and maintaining equipment, etc. And for that matter, how much of the $180 charge for $8 worth of medicine actually got paid and how much the insurance company bargained down - it appears some of the listed prices in medicine are about as real as the "full retail price" at a Kohl's sale.

The costs are directly linked to our desire to have the best (service), and our ability to use someone else's money to get it.

I do medical construction. My work (and its price) is directly linked to the same thing.

So, when I get a call to do upgrades to a suite to accommodate a new MRI machine, it's because patients don't want last year's model once one exists that is "better", and the costs are born by everyone else (insurance).

Most hospitals are ALWAYS under construction and improving. We have one hospital we've been working in continuously since 1998. Some hospitals have roof systems with lifting points so the roof can be craned off and new equipment craned in, they change so frequently.

The cost of our work is high because what we are being asked to do is so difficult. Sheetrock, welding, and concrete are very simple. Try doing them in an environment that mandates you work invisibly, silently, odor free, with staff that has impeccably clean backgrounds, and without a single micron of dust crossing barriers.

Our jobs routinely cost 5X or more than they should because if the customer's (patient's) expectations, and their ability to pay for it with other people's money.

I'd be driving a Ferrari if I could get all of you to pay for it.

The single payer systems (socialized medicine) that seem to work all have limits to the services they provide.

They may limit the doctors you can see, the dollar amounts, the approval of services for terminal patients, how quickly you can receive services, or they might use last year's MRI, but they all have limits.

We want no limits, and someone else to pay for it. We want perfect, free, and now.

It's a dream.

I'll throw my $.02 into the equation.

I work for a PA based Non-for-profit health insurance company ONLY available to residents in Central through Eastern PA and owned by a large hospital chain. Being that I technically work for both the medical side AND the health insurance side, I may have a more unique perspective than the layman or somebody not involved daily in the ins and outs of health insurance.

Specifically my profession is provider and customer relations as well as claims. I deal and see what is allowed for procedures as well as know how and what providers are paid for services and see what organizations are paid via Medicare, Medicaid, and Commercial sides.

My OPINION is that there are three MAIN (there are others, but these are primary) entities that drive up medical costs. Medical, Insurance, and Pharmaceutical with each one raising prices based on one or both of the others. So IMO, it's a problem of all three, not just the insurance or Medical side. Having profit in an industry is fine, but not when it's on the back of the sick, poor, and incapable of paying. It doesn't help anybody and puts more strain on government spending in the form of subsidies and benefits (not just Medicaid like everybody thinks). Just as Wal-Mart is a welfare king, supplementing it's workers with government benefits at our tax payer costs; insurance, medical and pharmaceutical are benefiting from government payments because the healthcare industry isn't sustainable as it's currently working.

My take, and I know it won't be popular, is that the medical side, insurance side, and pharmaceutical side are ALL over inflated and valued. They all live for and against each other and raise their prices and contractual agreements yearly in order to profit from one another. IMO, they're just inflating a balloon in the same aspect that the housing market values were over-inflated in 2007/2008. If things don't start having actually regulatory allowance adjustments for items like/such as Medicare/Medicaid allowances then without government help, nobody will be able to afford their insurance plans (especially considering inflation is stagnant, yet medical goes up from 5-10% YEARLY). The direct for-profit Medical system is showing it's incapable of regulating itself and pushing profits over medical care. Our system if very very flawed and I'd be willing to lose my job if it meant a sustainable health system was put into place instead.

My thoughts are a touch discojointed, but I'm sure my opinion is clear enough as indicated above. You can't blame everything on one of the three entities, without blaming the other two as well. Without one, the other two wouldn't be operating the way they are currently operating.

MadScientistMatt wrote: It would be interesting to see somebody draw up a pie chart of just what percent of the money goes where. How much the doctor keeps, how much goes to things like administration, malpractice insurance, buying and maintaining equipment, etc. And for that matter, how much of the $180 charge for $8 worth of medicine actually got paid and how much the insurance company bargained down - it appears some of the listed prices in medicine are about as real as the "full retail price" at a Kohl's sale.

I don't know where things are now, but a lot of my family is/was involved with medical either as doctors, nurses, techs, or administration (we're aging, most have retired now) but I remember my Mom mentioning that 2/3rd of the surgeons' take-home in the clinic where she worked was spent on malpractice insurance. This was in the 1980s.

One of the things I've learned from her is that the hospitals have no idea what things actually cost. They just spitball some huge numbers on their bills and they take what they can get after the insurance companies stongarm them and/or the people without insurance file for bankruptcy. They only figure that they will get 20% before people run out of money, so they hike the out-of-pocket rates accordingly.

At least, that was her explanation when I spent a fine weekend hooked to an IV and was presented with an enormous bill before they got my insurance sorted out, and then a week after that I was presented with an invoice that said that my insurance paid, literally, 10% of what my uninsured bill would have been, and that the bill was considered paid in full. No deductible. I had awesome insurance...

Interestingly, that was a long time ago, she has since changed careers a couple times and now she does database admin... for a large animal hospital.

Also, there's been rumors that automotive techs (my career of choice) will have to carry personal liability insurance, and shop labor rates will have to swell from the current $100-200/hour to $200-300/hour to cover that insurance. I've only been sued once in the past 21 years and that case was thrown out of court, but there's always rumours