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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 45
    More: Cool, dog food, free markets, pricing, anesthesiologists, health cares  
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13419 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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Archived thread
2012-11-18 03:07:45 PM  
9 votes:

Vectron: "One reason our prices are so low," says Smith, "is that we don't have administrators running around in their four or five thousand dollar suits.to deal with large numbers of poor, chronically ill, patients, because we choose instead to foist them off on public emergency rooms that can't turn them away

"

FTFY
2012-11-18 02:45:39 PM  
7 votes:
$o the Why ha$en't thi$ taken the Country by $torm?

Sorry but most doctors are greedier A$$holes than litigation lawyers
2012-11-18 02:59:40 PM  
6 votes:

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
2012-11-18 03:31:13 PM  
5 votes:
It's okay for the free market to decide the value of scarce things like yachts. The whole point of a market is to find the fairest way to distrbute scarce goods. If I don't get a yacht, oh well.

Medical care is another story.

1. There needs to be enough to go around.

2. EVERYONE should get it, even if it's free for some people.

Both 1 and 2 make society better for everyone. Applying a tool (the market) where is doesn't belong is nothing more than religious dogma, and it deserves to be cast aside.
2012-11-18 03:16:46 PM  
4 votes:
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.
2012-11-18 03:07:19 PM  
4 votes:

crazytrain: Open pricing would be a huge win for consumers. Just think of a travelocity-like site for commodity medical procedures and services. Show the prices for each provider along with a review. Sometimes I can find a way better airfare deal by traveling 90 minutes to the next closest city - would totally do the same for some types of medical services, but that's just me.


The problem is that most expensive medical services are usually in emergent or urgent care where you don't really have the luxury of shopping around.
This idea works well for elective procedures - not so good for any sort of emergency care, trauma, or expensive chronic treatment such as chemotherapy where the costs will always exceed the means of any average person.
2012-11-18 03:06:32 PM  
4 votes:
Next time I am hit by a bus I will carefully choose among competing emergency-care providers for the most cost-effective treatment.

Thanks for the advice, Libertarians!!
2012-11-18 03:00:09 PM  
4 votes:
Sounds great until greed kicks in, and then puts patients into the situation you see around the country currently.
2012-11-18 02:59:19 PM  
4 votes:
Because medical care was always regulated and we have zero history of unregulated medical care in this country as a measure of how this would play out on a larger scale, most notably towards the poor and elderly. Right.
2012-11-18 03:18:02 PM  
3 votes:
"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."

Stopped reading at this point, this old and tired idea just will not die no matter how much it doesn't fit the facts or the reasoning skills of someone above the 9th grade.
2012-11-18 03:17:36 PM  
3 votes:
This is a great idea. I just keep saying, make it totally free market. That way when Mitt Romney has a stroke, the neurosurgeon can decide he's not going to show up to work that day for less than $100,000,000. If he doesn't like it, he's more than welcome to spend those precious moments negotiating with one of the less than 3500 neurosurgeons that exist in the country.
2012-11-18 03:01:38 PM  
3 votes:

imgod2u: The problem with averages is that it hides the low point.


www.smbc-comics.com
2012-11-18 03:51:27 PM  
2 votes:
Want to reduce medical costs? Stop funding the search for the fountain of youth. Average recipient for Medicare spends 100k the last year of their life. Some rationale in treatment is due. No more spending 100k for a 6 month extension of life. Sorry. It is not affordable.
2012-11-18 03:37:11 PM  
2 votes:

iheartscotch: Meh; why worry about medical care? We're just going to blow ourselves up anyway. It's only a matter of time.

Either that; or we'll end up in one of these;

Progressive Paradise: where it is ok to censor art and media , because of teh children. And you can't defend yourself.

The authoritarian paradise; 1984, eat your heart out.

The libertarian paradise; bootstraps for your bootstraps

The facist paradise; foreigners and Jews cause all the problems

And, last, but not least Theocracy!

/ let's all sing the doom song


Dude. Put down the bong....
2012-11-18 03:21:10 PM  
2 votes:

Watching_Epoxy_Cure: Nothing surprising about it, Subby. An open market is almost always going to provide the consumer with the best service/goods available.


Yes, because health care should be just like televisions- Some people can afford real big, expensive ones, some can only afford small cheap ones, and some people can't afford one at all. But, hey, that's life.
2012-11-18 03:10:49 PM  
2 votes:
Nothing surprising about it, Subby. An open market is almost always going to provide the consumer with the best service/goods available.
2012-11-18 03:06:59 PM  
2 votes:
Outpatient ambulatory surgical centers are also pretty restricted in the level of surgery they can perform. You're not getting anything major done at a facility that can't respond with the resources of an acute care facility in case things go south on the table. I'm guessing that 80-90% of their business is colonoscopies and endoscopies, things that require only moderate sedation.

The one thing that they had right is that the driver in the cost of healthcare is the absolutely obscene profits that major hospitals make. If you really want to make a difference in this trend, have providers go through rate setting commissions just like payers do.
2012-11-18 02:59:41 PM  
2 votes:
Yeah, what happens if you need the surgery but don't have the cash (either from your own pocket or through insurance)?
2012-11-18 02:57:54 PM  
2 votes:
The problem with averages is that it hides the low point.
2012-11-19 02:10:33 AM  
1 votes:
Phins

So it doesn't pay for anything until we meet the $3000 deductible and only a small % of the actual cost will be applied to the deductible. So we don't get much coverage until we've spent $9000 in-network or $9000 out of network.


Reason #1 sh*t needs to change.

I work as a practice manager. I see a lot of these problems(this thread). I think, personally, Obamacare is a step in the right direction overall, albeit remaining something of a mixed bag. Care costs are indeed completely out of control. First let's look at current/future changes implemented by Obamacare:

Pluses:
No more uninsurable. We have some patients in the high risk pool now, and I can tell you it is something, that is, it's better than nothing, which is what these poor (literally & figuratively) sumbiches had before. This is by far the most significant portion of the legislation, and the most necessary. Also rules regarding dropping people who get sick - sorry, that's what the insurance business is. If you can't compete then we should nationalize your industry.
No more lifetime limits. Lifetime limits were bullshiat policies instituted by smart accountants to try to deal with outliers, like the guy who was born a hemophiliac, got hep c through a dental procedure, AIDS from a blood transfusion, got stable in 2009 but then developed treatable mesothelioma. Yes, there are a few people who have extremely complicated and expensive-to-treat condition, no I don't think we should abandon them.
Transparency increases.
Medicare refunds & gap coverage. Moar coverage for people on fixed incomes. Niiiiiiiiice.
Tax breaks for care increase.
No more federal insurance for Congress. Welcome to the real world, assholes.

Minuses:
Food labeling. When I want a Big Mac because I didn't get laid tonight, I'm not going to count the farking calories.
Requirements to buy a health plan. This is horsesh*t. If you require it you should provide a public option and then it's a tax. Forcing people to buy a private product (especially one as flawed as medical insurance) is unconscionable and morally indefensible. This is especially egregious because of the population it most affects the 20-somethings - the population least likely to need it or use it and most fiscally impacted because of where they are in life. This amounts to a wealth transfer from the healthy to the cost of the system, which is completely f**king broken.
More medicare documentation requirements. The one maxim about bureaucracy you can't escape is that they'll make more damnable paperwork for everyone.
Dr. pay determined by rating, which doesn't exist as a system yet. I put it in minuses because I assure you whatever is put in place will be inferior to Yelp in every way and it'll cost a pile of money to boot.

Mixed bag/too soon to tell:
More generics. This doesn't seem like it can be mandated into existence, but I guess we'll see what happens.
Tax increase on the wealthiest 5-7%.
Taxes on medical devices, pharma companies, insurance companies.
Medium-business requirements. This will help workers, but hurt growth.
Taxes are always mixed bag, although again I do not see why we should not have a public option with all the expense, regulation and taxing going on. It seems that the insurance companies will/have become unnecessary.


In my office, we are happy to provide our fees for services upfront to our patients, and certainly these Oklahoma docs are doing that. Perhaps the doctors also volunteer, like my employer, at a local free clinic. But the problem is too big to address in this manner; our system needs an overhaul the market cannot provide; ultimately whenever you have a product that people need in order to survive, you need either nationalization or intense regulation, otherwise you end up with profit at the expense of human life. Pithy statements about freedom and markets and capitalism don't mean a whole hell of a lot when your child needs an operation you simply can't afford. And evil insurance companies have no interest in the public good - they routinely deny medication in my office to people who without it cannot work, damaging the system one ruined life at a time. I make free use of the Dept of Insurance in my state to force the insurance companies to provide care, which they are legally obligated to do, to the very mother f**kers whose money they rely on to stay in business.

Maybe in someone else's' office, you were told your insurance denied a medication, but unless you have an exclusion in your policy, I will get it for you in mine. 

/some other time you can get me going on big pharma
2012-11-18 05:32:59 PM  
1 votes:
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 04:46:08 PM  
1 votes:

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 04:06:27 PM  
1 votes:

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 04:04:08 PM  
1 votes:

MyRandomName: If the government is spending 100k a year on a poor person to live 3 or 4 years, it is a shiat investment.


Not to that person, or his/her family.

While there are certain diseases, such as Alzheimers and Dementia, that should have limits and mandatory end of life planning, others are curable, and DO have survivors.
2012-11-18 04:02:37 PM  
1 votes:

MyRandomName: The fact is you can't save every human, or any, from death. Yet liberals put forth policy of all medical treatment for anyone. It is not a rational policy.


So you should not treat them at a cheap, preventative stage, but rather wait until they are a drain on the national healthcare finances?

You cannot deny life-saving medical treatment to someone. To do so is incredibly unethical, and violates every healthcare provider's oath. People have a right to die with dignity, and as free of pain as possible.

Something tells me that you'd rather them die on the streets if they can't afford out of pocket.
2012-11-18 03:44:57 PM  
1 votes:

Bendal: OTOH, when my wife's doctor sent her to Rex's ER for what she suspected was a blood clot in her leg, we went there on her recommendation to get a more specific test quickly. 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.


Ahhh, yet I'd take that experience with your wife and the suspected blood clot over my suspected blood clot (yes, same thing) experience at Wake. I ended up owing almost $100,000 at Wake for the same damn thing. They almost amputated my leg on two separate occasions when it didn't need amputation. They drew my blood a total of 13 times because of an abnormality in my white-blood cell count (each time the blood is drawn and tested, $350). They didn't bother to open my chart and see that the very first line in all my charts says I was born with a low white-blood cell count. Each and every white blood cell I had at that moment was in my right leg fighting the massive infection, they weren't in my left arm.
We left them with a big FU, went to Rex, they found that I had a massive Baker's Cyst rupture and a bone disease, all treatable without amputation. Ended up getting the care at Rex and surgery at Duke. And only at Duke because it was a very new bone-grafting surgery that only one surgeon in NC knew how to perform at the time. All of Rex & Duke's bills combined didn't reach the amount that Wake tried to charge me for their incompetence.

Excuse me, rant over. VERY happy you got the care for your surgery at Rex, and I'm sorry for your wife's experience there for the possible blood clot... but, it could've been worse, you could've gone to Wake :/
2012-11-18 03:40:31 PM  
1 votes:
Since when did Progressives censor art? Are you thinking of Giuliani's reaction to "Piss Christ"? Citation definitely needed.
2012-11-18 03:35:58 PM  
1 votes:
Meh; why worry about medical care? We're just going to blow ourselves up anyway. It's only a matter of time.

Either that; or we'll end up in one of these;

Progressive Paradise: where it is ok to censor art and media , because of teh children. And you can't defend yourself.

The authoritarian paradise; 1984, eat your heart out.

The libertarian paradise; bootstraps for your bootstraps

The facist paradise; foreigners and Jews cause all the problems

And, last, but not least Theocracy!

/ let's all sing the doom song
2012-11-18 03:19:49 PM  
1 votes:
My last doctor stopped accepting any health insurance from her patients. She just charged a flat $100 for each visit, paid in advance, and if you had a follow-up visit afterwards she would often not charge at all for it. She didn't hesitate to refer me to a specialist or a lab for further tests, and was more than willing to treat multiple ailments in one visit rather than telling me "let's deal with this first, then the other stuff later".

When I asked her why she didn't accept insurance any longer, she said the insurance companies always pressured doctors to see more and more patients each day, and treat only one illness or complaint per visit. She said the goal was to get patient visits with a doctor down to 15 minutes, and keep lab visits to a minimum.

/stopped seeing her when she started pushing herbal treatments and holistic living
//did catch my prostate cancer though
2012-11-18 03:16:54 PM  
1 votes:
Wasn't the research that underlies modern medicine underwritten with public money? Aren't the medical schools typically heavily subsidized by the state?
2012-11-18 03:15:19 PM  
1 votes:

jaytkay: Next time I am hit by a bus I will carefully choose among competing emergency-care providers for the most cost-effective treatment.

Thanks for the advice, Libertarians!!


Buses don't exist in a Libertarian utopia.
2012-11-18 03:13:54 PM  
1 votes:
Health care isn't as expensive if you don't have to use medications.
2012-11-18 03:12:26 PM  
1 votes:
Reason is such a funny site. They have some good articles, but seem to go out of their way to prove everything people hate about libertarians being assholes just for the hell of it.

Lance Armstrong Cheated to Win. Why is that Wrong?

and

FEMA: Welfare Masquerading as Disaster Relief
2012-11-18 03:12:04 PM  
1 votes:

Bonzo_1116: Yeah, what happens if you need the surgery but don't have the cash (either from your own pocket or through insurance)?


You go to the hospital and stiff them when the bill comes, just like everyone else.
2012-11-18 03:10:01 PM  
1 votes:

Rising_Zan_Samurai_Gunman: crazytrain: Open pricing would be a huge win for consumers. Just think of a travelocity-like site for commodity medical procedures and services. Show the prices for each provider along with a review. Sometimes I can find a way better airfare deal by traveling 90 minutes to the next closest city - would totally do the same for some types of medical services, but that's just me.

The problem is that most expensive medical services are usually in emergent or urgent care where you don't really have the luxury of shopping around.
This idea works well for elective procedures - not so good for any sort of emergency care, trauma, or expensive chronic treatment such as chemotherapy where the costs will always exceed the means of any average person.


Poor individuals should simply choose not to have cancer if they cannot afford it.
2012-11-18 03:08:59 PM  
1 votes:

fluffy2097: for $50. We'll give you a bottle of vodka to drink, and a table leg to bite down on


More like "$300 surgery-grade" vodka, run through a micron filter and produced under aseptic conditions. Otherwise, you get the meningitis vodka.
2012-11-18 03:07:23 PM  
1 votes:
Um, hasn't it been at least half free market? It is in my county at least. Yet everyone runs to the State owned besides the privately owned, no matter how close one is to the privately owned. It's cheaper and it's at least triple the quality.
2012-11-18 03:05:01 PM  
1 votes:

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.


I like the idea of a nationalized healthcare system. I would not be willing to abuse it, though. And that would be one of the biggest problems here in the USA. I had to go to a doctor the other day because of flu/URI. Doc kept asking about insurance. I told him I was paying cash. He was very happy about that (cutting down on paperwork and such) and even gave me some extra attention. So things like that are ok. But when greed takes over the minds of the patients, and the doctors, then the system breaks.
And that is why I hate everyone.
2012-11-18 03:03:00 PM  
1 votes:
What some Doctors may look like
img62.xooimage.com
/Yes, the one on the right isn't the original
2012-11-18 03:01:57 PM  
1 votes:
"One reason our prices are so low," says Smith, "is that we don't have administrators running around in their four or five thousand dollar suits."


It will never work. Those people are indispensible.
2012-11-18 03:01:35 PM  
1 votes:
I say good for them. I haven't been to this location yet, but I will the next time I end up needing something done.
2012-11-18 03:01:02 PM  
1 votes:

Bonzo_1116: Yeah, what happens if you need the surgery but don't have the cash (either from your own pocket or through insurance)?


Then you are poor and get your organs harvested. DERP
2012-11-18 02:59:28 PM  
1 votes:
Rich people should harvest the organs of the poor, in order to create jobs.
2012-11-18 02:57:33 PM  
1 votes:

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.
2012-11-18 02:56:50 PM  
1 votes:
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.
 
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