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(RealClearPolitics)   Some Doctors in Oklahoma came up with a genius idea. Why not let free markets and open pricing decide medical care. Surprisingly it has led to better care, lower costs and it isn't done in a back alley and no one is fed dog food   (realclearpolitics.com) divider line 192
    More: Cool, dog food, free markets, pricing, anesthesiologists, health cares  
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13418 clicks; posted to Main » on 18 Nov 2012 at 2:55 PM (2 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-11-18 04:05:40 PM  

WhippingBoy: They do that here in Canada, too. I can jump to the front of any waiting list just by ponying up a little extra dough.


Unless you're talking about getting an MRI scan at a private clinic, or "ponying up a little extra dough" in the sense of traveling to the USA and paying for treatment there, then this is the the falsest thing I've read today.
 
2012-11-18 04:06:27 PM  

WhyteRaven74: And yet plenty of countries do just that.


Yeah. Collectively, they are known as third world countries, or uncivilized hellholes where everyone lives miserably.

Those countries also tend to not have public sanitation and healthy drinking water. Next, malaria will be considered a priviledge for libertarians.
 
2012-11-18 04:06:37 PM  

DerAppie: Azlefty: $o the Why ha$en't thi$ taken the Country by $torm?

Sorry but most doctors are greedier A$$holes than litigation lawyers

A while back "we" deregulated dentist pricing. I came to the surprise of no one but the politicians that prices either stayed where they were or sky-rocketed. That free market experiment has been cancelled.

/You do not expect people to do the honourable thing
//Especially not when talking money


Deregulated dental care would by definition include higenists doing cleanings (without a dentist's 2 minute check) for $75 or so, the only reason they can't don't is due to regulations.
 
GBB
2012-11-18 04:06:45 PM  

OscarTamerz: The hospitals have to deal with unfunded mandates which say anyone can get free emergent care that shows up on their doorstep by federal law. The federal government doesn't pay a penny for this and healthcare is the only industry affected. Just imagine how much you'd pay for a car or food if every criminal alien that showed up at the dealership or supermarket didn't have to pay for their new S class Mercedes or steak and lobster. It's tantamount to a tax on sick people and the politicians know it and never talk about it.

The surgery center doesn't have to deal with any of that so it's disingenuous of them to pretend they've discovered this fantastic new business model that everyone else is too greedy to implement.


I think a better analogy would be to imagine how much public transportation would cost a paying customer if the bus had to provide free transportation to anyone that asks. Or how much a flight would be if airlines *had to provide free flights for active and retired military, LEO, Fire/medical personel, anyone claiming "hero" status, last minute bereavement, vicims fleeing domestic violence situations, poor, unemployed looking for a job, or any other reason you can think for not wanting to pay for a flight that isn't vacation related.

*had to provide as opposed to some of the generous offers airlines currently budget for.
 
2012-11-18 04:12:17 PM  

Bendal: Heh. The only way I would go to Wake is if I was unconscious and my wife was nowhere near. If I was in a car crash in front of Wake and I was conscious, I would demand to go to Rex before I'd let them take me into Wake. I've heard way too many stories from coworkers, neighbors and friends who went to Wake and developed secondary infections, had long recovery times, and expensive bills.


Smart man... I've thought about getting a tattoo on my chest to something among the lines of: "I'd rather die than go to Wake... 'cause I'd probably end up dead anyways. Take me to Rex or allow me to die in peace on the street. Thanks!" Throw in some birds on either side or something.
 
2012-11-18 04:14:59 PM  

TuteTibiImperes: Open pricing is a nice step forward, but this still isn't as beneficial as a true single-payer system would be.

Health care should not be a for-profit business.

With a true single payer system it would be easy to control costs, just state in law that all licensed medical facilities must accept MediCare for 100% of all procedures, and accept whatever MediCare pays as 100% fulfillment of the bill. Then, you just set the amount MediCare pays to make services affordable. Set an MRI at $500, fitting a cast at $100, complex surgery at $100/hr, etc, and set the prices MediCare will pay for drugs and that becomes all the pharmaceutical companies can ask.

Everyone is covered, costs are reduced, and hospitals will be forced to become more efficient to stay in business. Salaries for doctors, surgeons, and administrators will likely go down, but it would be for the common good.


Great. Now what do you do when the costs exceed what gets paid? Because that's what happens with Medicare right now. Why do you think the OTHER insurances are billed higher? To cover the lose on Medicare. Don't believe me? Go ask a doctor why they stop accepting Medicare.
 
GBB
2012-11-18 04:19:32 PM  

Treize26: There are quite a few problems with healthcare in this country. First is the insurance industry. If you have insurance, you don't care what things cost, so why bother shopping around? I'm guilty of this as well.

Relating to point one, we have doctors who charge $500 for a procedure, of which the insurance company only pays, say $100. The guy with insurance doesn't know any better, and thinks his insurance is a life-saver. The guy walking in off the street uninsured is stuck with that full $500, despite the fact that it's clearly a $100 procedure. "Free market" broken at this point. The intersection between supply and demand occurs behind the scenes, the price of the service is vastly inflated and most people are none the wiser.

Because of the combination of insured not caring about prices, and doctors charging uninsured absurdly inflated rates, we have a system that as a whole, costs significantly more than it should.

2 things would solve this in my mind, either single-payer universal healthcare, which protects previously uninsured people from being essentially exploited and put into debt for having the audacity to be ill, or the complete dissolution of the health insurance industry.

Getting rid of the health insurers would remove the complexity of "is this covered, is this doctor in my network", etc, and I believe that overall prices would plummet, as the vast majority of the population couldn't begin to afford even the basic treatments that they take for granted while insured currently.

Personally, I favor the universal healthcare route, as this method is the least likely to have greed enter into the equation and ruin everything, and at the end of the day, wouldn't be nearly as significant a change to the existing infrastructure of our healthcare industry.

//huh... and I used to be a die-hard conservative as well.


I think there are many misconceptions and a lot of false leads when it comes to trying to solve our healthcare system.

All costs have been computed with actual costs and a little profit. Collectively, all the prices for procedures are calculated to insure profit for the insurance company and healthcare providers in the network. The insurance company then sells their plans to customers for profit as well. If one tries to look at an individual cost for service, it's always going to look as though someone is getting screwed. And that is simply because you are looking at a very narrow segment of the accounting system. It's not designed to be scrutinized like that.

These Doctors that the article is about have done something that makes sense for their own specialized market. If they decide to expand their operation and NOT franchise it, they would then want to create a home office to coordinate and manage all their locations. Then you would see their prices soar because then they would have administrators, board of directors, 15 executives, and enough secretaries to go around. It would be exactly like the hospital corporation they just left. So, in a sense, the solution is to ban the practice of having hospital corporations and mandate that the entire operation be housed in the same complex. Or, even more simply, "smaller is better".
 
2012-11-18 04:22:58 PM  

TuteTibiImperes: Open pricing is a nice step forward, but this still isn't as beneficial as a true single-payer system would be.

Health care should not be a for-profit business.

With a true single payer system it would be easy to control costs, just state in law that all licensed medical facilities must accept MediCare for 100% of all procedures, and accept whatever MediCare pays as 100% fulfillment of the bill. Then, you just set the amount MediCare pays to make services affordable. Set an MRI at $500, fitting a cast at $100, complex surgery at $100/hr, etc, and set the prices MediCare will pay for drugs and that becomes all the pharmaceutical companies can ask.

Everyone is covered, costs are reduced, and hospitals will be forced to become more efficient to stay in business. Salaries for doctors, surgeons, and administrators will likely go down, but it would be for the common good.


Do you even know how expensive an MRI machine is? Or how much it costs to fix it when it is not operating? Do you understand how expensive the cost of labor is to do that surgery? How could a hospital possibly pay multiple medical professionals who must be present at a surgery by only charging $100/hour?

You are clueless. Even non-profit hospitals charge about the same as a for-profit hospital for services...and if you read the article, you would see why. To cover the costs of those without insurance, plus the underpayment of Medicare for services rendered to the elderly.
 
2012-11-18 04:29:49 PM  

k1j2b3: Do you even know how expensive an MRI machine is?


MRI machines are expensive but they can be used quite a lot, so the actual cost per use isn't very much.
 
GBB
2012-11-18 04:30:11 PM  
I'm not entirely convinced that everyone knows the difference between for-profit and not-for-profit.

The difference is in how investors are paid.
For-profit means that the corporation has the option of distributing profits to investors in the form of dividends. If the business does well, they declare a dividend to be paid to investors out of the profit. Commonly, executives are given stocks or options to buy stocks as a form of compensation. They get paid more if the business does well and their strategy would be more profit driven.

In a not-for-profit, profits must remain in the company and used only for expansion or paying debts. Not-for-profits can not distribute profits to employees or investors. All employees are paid through salaries or wages. Depending on regulations, bonuses may be paid on a contractual basis tied to specific productivity goals.

In either case, profit motive still exists.
 
2012-11-18 04:31:08 PM  

k1j2b3: You are clueless.


Speaking as a strictly lay-man who was having to have an MRI at least once a month for about a year... I personally, really could not afford the $1K each time... just saying. I have no dog your fight with whoever, but that shiat is too expensive for the average american who lives salary if not hourly.
 
2012-11-18 04:32:45 PM  

GBB: I'm not entirely convinced that everyone knows the difference between for-profit and not-for-profit.

The difference is in how investors are paid.
For-profit means that the corporation has the option of distributing profits to investors in the form of dividends. If the business does well, they declare a dividend to be paid to investors out of the profit. Commonly, executives are given stocks or options to buy stocks as a form of compensation. They get paid more if the business does well and their strategy would be more profit driven.

In a not-for-profit, profits must remain in the company and used only for expansion or paying debts. Not-for-profits can not distribute profits to employees or investors. All employees are paid through salaries or wages. Depending on regulations, bonuses may be paid on a contractual basis tied to specific productivity goals.

In either case, profit motive still exists.


This has got to be one of the most thought out statements I have read on Fark in a long time.
 
2012-11-18 04:34:08 PM  

Bendal: did catch my prostate cancer though


OMG, I had no idea this was contagious!
 
2012-11-18 04:37:51 PM  
In November 2011 I got hepatits A and went to the emergency room. I was there about four hours.
The total amount for services on the bill was $3,500. But because I had insurance, a magic wand was waived and the total amount paid was around $2,000. Yet according to the knuckleheads at Reason, I'm the problem because I didn't think to negotiate prices for services while I was doubled over in pain.

Facilities specifying their prices up front would be a good step......but from my experience it is clear there are much bigger things causing these problems.
 
2012-11-18 04:39:39 PM  

WhyteRaven74: k1j2b3: Do you even know how expensive an MRI machine is?

MRI machines are expensive but they can be used quite a lot, so the actual cost per use isn't very much.


I looked it up. MRI machines cost between $1M and $3M. Do you know how many MRIs you'd have to do to recoup costs if you charged only $500 per MRI? What about smaller hospitals that don't have the demand for a lot of MRIs, but yet need that technology in order to compete? We are talking about a LOT of small-town non-profits who must have these tools available, but who will take years and years to recoup the cost of the machines.
 
2012-11-18 04:40:23 PM  

Azlefty: $o the Why ha$en't thi$ taken the Country by $torm?

Sorry but most doctors are greedier A$$holes than litigation lawyers


It's because the AMA has a monopoly on health care in this country.

It also irritates me when people refer to health insurance as "health care." Insurance companies are the other reason hospitals charge so much. So, by all means, let's give the insurance providers more power with Obamacare.
 
2012-11-18 04:44:42 PM  

BronyMedic: MyRandomName: You can't provide every treatment for every person

So you should not treat them when they are at a cheap stage, but rather let them get decompensated and progressed to the point where an emergency room is the only option?

Or we should let them die in the streets?


Not in the streets.. my tax dollars pay for those. Can't they die in a ditch instead?
 
2012-11-18 04:45:25 PM  
I hate to break to news to you guys but this is likely what's going to happen. To control costs by 2020 virtually everybody will have a health plan that has a 2000/4000 deductible, with the possibility of a pharmacy rider. If you're lucky you might have an employer to reimburse a portion, but more and more people will begin "shopping around" their doctors, and the difference between "in-network" and "out-of-network" will disappear, as you are largely paying out of pocket and being reimbursed from an FSA/HSA. The insurance plan simply needs to be informed of the visit and track it towards the deductible, the health plan only steps really when their is a catastrophic event.

Right now the 2000/4000 is the highest allowed (to be implemented by 2016 or something) but that will likely raise at the insistence of insurance companies to 3000/6000, 5000/10000, etc. Thus, most health care being out of pocket. The premiums are being controlled (price caps), so to even out the back end they will simply push more costs on the front end: the deductible.

Don't expect to be paying copays in 5 years.
 
2012-11-18 04:46:06 PM  

k1j2b3: TuteTibiImperes: Open pricing is a nice step forward, but this still isn't as beneficial as a true single-payer system would be.

Health care should not be a for-profit business.

With a true single payer system it would be easy to control costs, just state in law that all licensed medical facilities must accept MediCare for 100% of all procedures, and accept whatever MediCare pays as 100% fulfillment of the bill. Then, you just set the amount MediCare pays to make services affordable. Set an MRI at $500, fitting a cast at $100, complex surgery at $100/hr, etc, and set the prices MediCare will pay for drugs and that becomes all the pharmaceutical companies can ask.

Everyone is covered, costs are reduced, and hospitals will be forced to become more efficient to stay in business. Salaries for doctors, surgeons, and administrators will likely go down, but it would be for the common good.

Do you even know how expensive an MRI machine is? Or how much it costs to fix it when it is not operating? Do you understand how expensive the cost of labor is to do that surgery? How could a hospital possibly pay multiple medical professionals who must be present at a surgery by only charging $100/hour?

You are clueless. Even non-profit hospitals charge about the same as a for-profit hospital for services...and if you read the article, you would see why. To cover the costs of those without insurance, plus the underpayment of Medicare for services rendered to the elderly.


I pretty much pulled those amounts out of my ass. The actual amounts of payout could be determined by a panel that analyzes all of the numbers to find the 'break even' point, I was just throwing up figures as an example, I might as well of said '$twoducks' for a MRI.

Set the costs so that they are the minimum that can sustain service, and operate it as a taxpayer funded single-payer system. Everyone pays in because everyone pays some form of taxes (even if it's just payroll deductions). Well, illegal immigrants don't, so when they show up, treat them, get them healthy, and give them the option of starting the naturalization process immediately to become tax-paying citizens, or being sent back where they came from (or Sweden).

Some costs are going to be fixed - a MRI machine costs what it costs, but cost of labor can be negotiated. Find the minimum amount that doctors/surgeons can be paid before they leave the profession or leave the country, and pay that. Costs of drugs could also be greatly reduced. There's no reason that MediCare should have to pay $500 for a dose of medicine that costs $1.50 to produce when most of that profit to the drug company goes straight into a marketing campaign. Make it illegal to advertise prescription drugs, set strict limits on how pharma reps and doctors can interact, and watch drug costs fall. Even better, have drug research be funded for the government with all of the products that develop immediately becoming public domain that can be prescribed and sold for only marginally more than the cost of production.
 
2012-11-18 04:46:08 PM  

k1j2b3: I looked it up. MRI machines cost between $1M and $3M. Do you know how many MRIs you'd have to do to recoup costs if you charged only $500 per MRI?


Not hard to calculate: $2000000/$500=4000 scans. At 1 hour per scan, assuming you used the machine for 8 hours/day, it would take 500 days to recoup the cost. Assuming it sits idle on weekends (i.e., not located in a hospital, but in a private radiology office), that's 100 work-weeks -- almost 2 years exactly. That's a very reasonable amount of time, actually.
 
2012-11-18 04:53:25 PM  

TuteTibiImperes: k1j2b3: TuteTibiImperes:

Some costs are going to be fixed - a MRI machine costs what it costs, but cost of labor can be negotiated. Find the minimum amount that doctors/surgeons can be paid before they leave the profession or leave the country, and pay that. Costs of drugs could also be greatly reduced. There's no reason that MediCare should have to pay $500 for a dose of medicine that costs $1.50 to produce when most of that profit to the drug company goes straight into a marketing campaign. Make it illegal to advertise prescription drugs, set strict limits on how pharma reps and doctors can interact, and watch drug costs fall. Even better, have drug research be funded for the government with all of the products that develop immediately becoming public domain that can be prescribed and sold for only marginally more than the cost of production..


The only thing in that statement that I 100% agree with in terms of controlling costs. I would say, for prescription only medication as well. Let them advertise OTC to their hearts content.
 
2012-11-18 04:56:49 PM  

BronyMedic: WhippingBoy: They do that here in Canada, too. I can jump to the front of any waiting list just by ponying up a little extra dough.

Some people... poor people... have a problem with this; to me, it's just capitalism in action.

Let them eat cake, Sir.


hey Bro, answer your e-mail, kthx
 
2012-11-18 04:57:02 PM  

jshine: k1j2b3: I looked it up. MRI machines cost between $1M and $3M. Do you know how many MRIs you'd have to do to recoup costs if you charged only $500 per MRI?

Not hard to calculate: $2000000/$500=4000 scans. At 1 hour per scan, assuming you used the machine for 8 hours/day, it would take 500 days to recoup the cost. Assuming it sits idle on weekends (i.e., not located in a hospital, but in a private radiology office), that's 100 work-weeks -- almost 2 years exactly. That's a very reasonable amount of time, actually.


Oh great... here comes another libtard with his "math" to try to make his point.

Why is it so hard for you libs to understand that no country can provide free healthcare for its citizens. It's impossible. That's why it's never been tried.
And don't start with the "They do it in Canada"... that's complete bullshiat... everyone knows that Canada isn't even a real place.
 
2012-11-18 04:58:39 PM  

jshine: Not hard to calculate: $2000000/$500=4000 scans. At 1 hour per scan, assuming you used the machine for 8 hours/day, it would take 500 days to recoup the cost. Assuming it sits idle on weekends (i.e., not located in a hospital, but in a private radiology office), that's 100 work-weeks -- almost 2 years exactly. That's a very reasonable amount of time, actually.


I knew a sales guy for some kind of scan machine (MRI, Cat Scan, I dont know exactly) and that's exactly how he sold it. The company sold them with interest free financing so the revenue matched the monthly payment, after about 2 years it was pure profit to the Hospital. Said it was the easiest sale he ever did. That was some years ago though.
 
2012-11-18 05:01:38 PM  

jshine: k1j2b3: I looked it up. MRI machines cost between $1M and $3M. Do you know how many MRIs you'd have to do to recoup costs if you charged only $500 per MRI?

Not hard to calculate: $2000000/$500=4000 scans. At 1 hour per scan, assuming you used the machine for 8 hours/day, it would take 500 days to recoup the cost. Assuming it sits idle on weekends (i.e., not located in a hospital, but in a private radiology office), that's 100 work-weeks -- almost 2 years exactly. That's a very reasonable amount of time, actually.


You're right, it's just like how the total cost of a car is MSRP+10 years of gas and tires.
 
2012-11-18 05:02:29 PM  

maggoo: WhyteRaven74: And yet plenty of countries do just that.

Yeah. Collectively, they are known as third world countries, or uncivilized hellholes where everyone lives miserably.

Those countries also tend to not have public sanitation and healthy drinking water. Next, malaria will be considered a priviledge for libertarians.


Sure, countries like the United Kingdom, Iceland, France, Canada, Germany.... Incidentally, most of them have higher life expectancies and quality of life than the US, but that couldn't possibly have any relationship, right? The rest of the first world manages to provide all their citizens with lifesaving care and the basic necessities for survival, but we couldn't do that here because it would Commi-nism and it might cost some poor millionaire a few extra dollars on his tax returns, so the best idea is to let the people who can't pay whatever the "free market" decides they can charge die.
 
2012-11-18 05:05:45 PM  

ChuDogg: I knew a sales guy for some kind of scan machine (MRI, Cat Scan, I dont know exactly) and that's exactly how he sold it. The company sold them with interest free financing so the revenue matched the monthly payment, after about 2 years it was pure profit to the Hospital. Said it was the easiest sale he ever did. That was some years ago though.


The Feds reduced the reimbursement rate significantly in 2006 as part of the Deficit Reduction Act of 2005.
 
2012-11-18 05:06:16 PM  

TuteTibiImperes: Open pricing is a nice step forward, but this still isn't as beneficial as a true single-payer system would be.

Health care should not be a for-profit business.

With a true single payer system it would be easy to control costs, just state in law that all licensed medical facilities must accept MediCare for 100% of all procedures, and accept whatever MediCare pays as 100% fulfillment of the bill. Then, you just set the amount MediCare pays to make services affordable. Set an MRI at $500, fitting a cast at $100, complex surgery at $100/hr, etc, and set the prices MediCare will pay for drugs and that becomes all the pharmaceutical companies can ask.

Everyone is covered, costs are reduced, and hospitals will be forced to become more efficient to stay in business. Salaries for doctors, surgeons, and administrators will likely go down, but it would be for the common good.


Medicare/Medicaid rates are laughable and in their current state would make many practices run into bankruptcy. Driving down compensation of physicians (a small slice of the overall pie when you look at the numbers) is guaranteed to drive the talent out in droves.
 
2012-11-18 05:08:01 PM  

Doom MD: TuteTibiImperes: Open pricing is a nice step forward, but this still isn't as beneficial as a true single-payer system would be.

Health care should not be a for-profit business.

With a true single payer system it would be easy to control costs, just state in law that all licensed medical facilities must accept MediCare for 100% of all procedures, and accept whatever MediCare pays as 100% fulfillment of the bill. Then, you just set the amount MediCare pays to make services affordable. Set an MRI at $500, fitting a cast at $100, complex surgery at $100/hr, etc, and set the prices MediCare will pay for drugs and that becomes all the pharmaceutical companies can ask.

Everyone is covered, costs are reduced, and hospitals will be forced to become more efficient to stay in business. Salaries for doctors, surgeons, and administrators will likely go down, but it would be for the common good.

Medicare/Medicaid rates are laughable and in their current state would make many practices run into bankruptcy. Driving down compensation of physicians (a small slice of the overall pie when you look at the numbers) is guaranteed to drive the talent out in droves.

^THIS^
 
2012-11-18 05:10:54 PM  
Does the surgery center cover traumas, which are often uninsured?

Does the surgery center have an ER, that has to take on all patients and care for them regardless of their ability to pay?

Does the surgery center have to have staff in-house to cover trauma, airway, codes, and other emergencies?

Does the surgery center perform complex vascular procedures with patients with lots of comorbidities that often spend days in the ICU afterward?

Does the surgery center accept lower medicare and medicaid payments?

I will agree that all hospitals could stand to improve their efficiency. I will tell you that the hospital I work at absolutely fails in our ability to get one patient out of the room and get the anesthesia/surgery started on the next one.

But to compare the cost structures of a surgery center vs a large hospital, perhaps a level 1 trauma center is incredibly misleading. What's even more misleading is the idea that the business model of the surgery center is the result of libertarianism vs the other hospital being the result of Obamacare. This is a shameful, misleading POS hit-piece that aims to blame the inefficiencies of a large hospital on a piece of legislation that has NOT TAKEN EFFECT YET.

Moreover, if you want that hospital to improve efficiency, how about not making them provide services for free? So what if everybody that comes into the ER is suddenly insured? What if everybody who comes into the trauma bay and gets an emergency thoracotomy with 30 units of blood transfused and a two-week ICU stay is suddenly insured? What if you suddenly don't have to pass on the cost of that surgery to the guy getting a carpal tunnel release?

Please, Republicans on this thread, read that paragraph above and think about it. If everybody is insured, then suddenly a good size of the costs the average hospital usually has to either eat or pass on to the patients and insurers who can pay, suddenly disappear. This is the whole point of Obamacare.

Granted, I hate Obamacare because it was a weak, half-assed measure that doesn't go far enough. I would have settled for a public option. In reality, what we need is some sort of hybrid single payer/private insurance model. Single payer system for all primary care visits and preventive care, individual mandate for emergency and catastrophic care, and then people can perhaps purchase extra insurance if they want to cover non primary, non preventive, non emergency and non catastrophic care like hip surgeries and the like. Hospitals would have a lot less overhead and could charge a lot less as a result, and patients would not be left out in the rain for basic human-right type healthcare, but our country could still demand a bit of boot-strappiness from them if they wanted something more.
 
2012-11-18 05:11:29 PM  

Bendal: We waited for about 4 hours in the ER before seeing a doctor, who examined her leg and told us "she was wrong, your leg is fine" and sent us home without any tests, medication or anything else. The bill for that ER visit was over $600 for 5 minutes with a staff doctor who did nothing.


You think that taking up space in their waiting room for 4 hours comes for free??
 
2012-11-18 05:13:49 PM  

Doom MD: TuteTibiImperes: Open pricing is a nice step forward, but this still isn't as beneficial as a true single-payer system would be.

Health care should not be a for-profit business.

With a true single payer system it would be easy to control costs, just state in law that all licensed medical facilities must accept MediCare for 100% of all procedures, and accept whatever MediCare pays as 100% fulfillment of the bill. Then, you just set the amount MediCare pays to make services affordable. Set an MRI at $500, fitting a cast at $100, complex surgery at $100/hr, etc, and set the prices MediCare will pay for drugs and that becomes all the pharmaceutical companies can ask.

Everyone is covered, costs are reduced, and hospitals will be forced to become more efficient to stay in business. Salaries for doctors, surgeons, and administrators will likely go down, but it would be for the common good.

Medicare/Medicaid rates are laughable and in their current state would make many practices run into bankruptcy. Driving down compensation of physicians (a small slice of the overall pie when you look at the numbers) is guaranteed to drive the talent out in droves.


What is the big piece of the pie that can be addressed then? Drug costs are part of it I'm sure, and the government needs to take on the pharmaceutical companies to get that in line. Some serious tort reform to limit malpractice liability and help reduce the cost malpractice insurance would also help.
 
2012-11-18 05:16:54 PM  
Um...medical care isn't a luxury. It isn't caviar, where the free market can get you the best caviar at the lowest price, but still unaffordable to many. Everyone NEEDS medical care.
 
2012-11-18 05:17:25 PM  
They aren't a hospital with an ER, so they aren't required to serve non-paying patients for free.

Not even remotely an apples-to-apples comparison. Instead of comparing them to a hospital, compare them to other private surgery centers.

/Still sounds like a nice place though.
 
2012-11-18 05:19:15 PM  

WhyteRaven74: MyRandomName: You can't provide every treatment for every person.

And yet plenty of countries do just that.


And do it better and cheaper than us.
 
2012-11-18 05:29:03 PM  

WhippingBoy: They do that here in Canada, too. I can jump to the front of any waiting list just by ponying up a little extra dough.

Some people... poor people... have a problem with this; to me, it's just capitalism in action.


yeah, that's not a free market.
 
2012-11-18 05:30:48 PM  

crazytrain: Open pricing would be a huge win for consumers.


Why do _I_ care? My insurance is paying for it. Actually, the way the system currently is, I have every incentive to get the most expensive service possible.
 
2012-11-18 05:32:53 PM  
the system we have in place works much, much better than the free market would.

/no it doesn't. it is not even close.
 
2012-11-18 05:32:59 PM  
Yet another case of cherrypicking a smaller outlier within an overall model and falsely extrapolating it to mean the entire system would work if it was run the same way.

It's like driving on the shoulder in a traffic jam. If you're the only one doing it, and there are no cops or people on the shoulder to run over, you think you've hit on a great idea and everyone else is stupid for sitting in line. But it won't work if everyone does the same thing.

This is what libertarians don't get about their theories. They are not proven on a macro scale, but they think they're not only proven, but solid economic law. It's one of the biggest knowledge gaps in existence.
 
2012-11-18 05:34:42 PM  

CapeFearCadaver: I actually did do this once inside of an ambulance. I said take me to Rex or leave me where I am. They said they were employed by Wake and had to take me there so I told them I'd rather die in the street; we were physically much closer to the hospital that I asked for. Kudos to them, they called the other ambulance service in the city who were not employed by the privatized hospital and took patients to the closest hospital as opposed to the one who... sucks donkey-balls.


Wish I had thought of that when they were transferring my son to another hospital (the one he was born in had no NICU). I now have a $2700 bill for the transport because the ambulance company is 'out of network'. Silly me should have called around and found the in-network guys I guess. It didn't really occur to me at the time, I was more worried about my 1 day old son being unable to breathe.

/Ended up being a collapsed lung
//Full recovery, just a small scar from the chest tube
///10k in various other bills after the insurance paid their part
 
2012-11-18 05:37:35 PM  

maggoo: WhyteRaven74: And yet plenty of countries do just that.

Yeah. Collectively, they are known as third world countries, or uncivilized hellholes where everyone lives miserably.

Those countries also tend to not have public sanitation and healthy drinking water. Next, malaria will be considered a priviledge for libertarians.


I'm hoping that was a misguided attempt at sarcasm. Failing that, I'm hoping you just misunderstood what WhyteRaven74 was saying.
 
2012-11-18 05:38:00 PM  

The Southern Dandy: WhyteRaven74: MyRandomName: You can't provide every treatment for every person.

And yet plenty of countries do just that.

And do it better and cheaper than us.


B-b-but Norway doesn't have the blacks, and the messicans! Universal healthcare won't work because lazy poor people.
 
2012-11-18 05:42:17 PM  
The real concern in the coming years will not be cost as much as availability. As we add 40 million people to the health care rolls and have so many millions of baby boomers aging, there will probably not be enough doctors to do all of the knee and hip replacements that people need. The ACA ("Obamacare") doesn't address this problem. Neither did it address costs, which are much higher in this country with worse outcomes than many countries with socialized medicine.

Still, this is an interesting concept. I suspect medical tourism may play a big role for baby boomers needing treatments that are too pricey or have too long a waiting list in this country.
 
2012-11-18 05:51:59 PM  
25.media.tumblr.com

Can't believe I'm the first with this.
 
2012-11-18 05:57:39 PM  
Because private insurance companies or the government generally pick up most of the tab for medical services, patients don't have the normal incentive to seek out value.

Uh... this is supposed to be the purpose of insurance companies and government agencies. You see, insurance companies and government agencies are supposed to have specialized knowledge which allows them to assess potential cost based on cost of procedures, complications, likelihood of recovery, additional therapies and treatments, etc., from a host of treatment centers. As well, providers have greater bargaining power to reduce costs before hand. Patients have the incentive to seek out value via the provider but are f*cked due to the expansive and overwhelming nature of potential medical concerns including a myriad of lifestyle indicators, genetic markers, and flatly random occurrences such as accidents which one could never adequately prepare for. And because there are hassles with insurance providers, such as increased premiums or paying out of pocket, for seeking out regular check-ups and early symptoms, the patient puts off preventative treatment of more severe ailments.

When patients have to seek out value, patients are often in emotional states due to personal or familial ailments which necessitate medical care. Otherwise, the value patients seek out is of quality medical care, minimizing complications, etc., not the least immediate cost. The value insurance providers try to create is through denying payments or minimizing immediate cost, backing this with litigious strength.

"It's always been interesting to me," says Dr. Jason Sigmon, "that in any other industry, tons of attention is devoted to making systems more efficient, but in health care that's just completely lost."

Probably because the research background which provides you the equipment, medicines, procedures, and training you yourself have not developed by hand is concerned with efficiency in terms of saving lives and increasing quality of life by reducing complications and length of recovery. Efficiency in medicine and education are entirely different beasts from other areas.

Because bills charged by Integris are paid primarily by insurance companies or the government, the hospital gets away with gouging for its services. ... The bill, which is strictly for the hospital itself and doesn't include Sigmon's or the anesthesiologist's fees, totaled $33,505. When Sigmon performs the same procedure at the Surgery Center, the all-inclusive price is $5,885.

Which means the Surgery Center has patients who are able to afford medical care not paid via insurance companies or government programs? No kidding the costs are lower.
 
2012-11-18 06:09:58 PM  
If free market health care works so well why is it being replaced by "Obamacare"?
 
2012-11-18 06:22:44 PM  
so is the price of abortions going down in oklahoma?
 
2012-11-18 06:27:01 PM  
I'm stunned that no one thought of this 20 years ago...

oh, wait.
 
2012-11-18 06:46:50 PM  

dennysgod: If free market health care works so well why is it being replaced by "Obamacare"?


Power and money.

Obamacare was unpopular when it passed, and they said they would need to pass it before we could learn what was in it. Its penalties on employing people have kept the economy screwed up, and it's the biggest tax increase in American history (yet to really be felt by we the people).

BTW, why do you call the current government screwed up system "free market health care"?
 
2012-11-18 06:49:43 PM  

Azlefty: $o the Why ha$en't thi$ taken the Country by $torm?

Sorry but most doctors are greedier A$$holes than litigation lawyers


Oh! I get it! DOLLAR SIGNS!

/That's rich!
//Get it? RICH?
 
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