Why our Healthcare is so Expensive

[Nymeria Sand]

How so? Surely proper documentation is an important element of proper patient treatment. If doctors choose to treat more patients rather than treat the patients they do have properly, you should blame the doctors.

Agree. Also, if doctors document everything, why don't they ever know what medications you're taking? Shouldn't that be recorded somewhere? If it is (and I'm sure it is), then they're just plain not even reading your chart before they see you.

Overscheduling is a good way to make mistakes. That goes for everyone from the receptionist to the nurse to the doctor. You're rushed and you can't do a good job.

[Mlle. Zabzie]

BMI charts are inaccurate in measuring a individuals body composition. I specifically used body fat % for a reason. It would take a nurse approximately an extra 20-30 second to assess and record BF% when she/he weighs you and takes your blood pressure.

Doctors and Nurses are already reporting the information to your State's Health Dept. In a perfect world doctors and health care professionals would concentrate 100% on the wellness of their patients. They can't in the current system. Legal & monetary needs forces documentation of everything they see, say, do which takes away from the time they can spend assessing, treating and/or educating the patient.

BMI/Body Fat % - tomato tomahto - it will still add more complexity to an already overly complex tax code. I don't even want to KNOW what the regulations would look like (but I know they would be HORRIFIC). What would everyone get, a 1099-HEALTH every year? REALLY? Would all doctors be "accredited"? How would they prove their bona fides to the IRS? How would you monitor corruption (I mean, look at medicare fraud)? How would the standards be arrived at? Probably some legislative compromise. Yippee! Congress gets to decide what makes me healthy (with the good Senators from Mississippi reaching a compromise with their esteemed colleagues from Colorado - I think we all know what that looks like).

Having dealt with the horror shows that are Sections 280G and Section 162(m) (and now Section 409A), I can tell you that tax legislation that is intended to change behavior DOES NOT WORK as intended. It just doesn't.

[LCOTNW]

Agree. Also, if doctors document everything, why don't they ever know what medications you're taking? Shouldn't that be recorded somewhere? If it is (and I'm sure it is), then they're just plain not even reading your chart before they see you.

Overscheduling is a good way to make mistakes. That goes for everyone from the receptionist to the nurse to the doctor. You're rushed and you can't do a good job.

There was an interesting interview with someone today on NPR. I forget her name, but she is one of the medical consultants for House. One of the comments she made in reference to HCR was that the current system is designed to reward doctors for "doing" not for "thinking". She pointed out that if you look at the history of medicine, it is thinking/listening/researching that solves most patient problems, not doing procedures. On House, you'll see the repeated theme of House criticizing his minions for failing to take a proper medical history which would have saved them all a bunch of time and unnecessary tests. Part of that is related to research that shows that in taking a patient history, (i.e. "what seems to be wrong today?") the doctor will interrupt after the patient starts explaining after just a few seconds. The doctor in the radio interview revealed that the average patient will explain their problem in roughly 2 minutes and apparently there are studies that show that more careful listening to the patient will usually result in skipping unnecessary testing. She also decried the decline of doing an actual physical exam since the emphasis has shifted towards doing lab tests and using that almost exclusively to diagnose the problem. She also related a study which shows that roughly 50% of the time, when the patient leaves the doctor's office, the doctor and the patient will describe different purposes for the visit, and the patient will often reveal additional symptoms that the Dr. never heard due to interrupting the patient and trying to drive the conversation. The obvious source of this impatience is the need for the Dr. to move things along for business/insurance reasons.

[Tormund Ukrainesbane]

I'll see if I can dig up the article I was reading a few months back on this. It was interesting how many doctors were performing the most complicated tests they could, because it made them more money then the cheaper but just as effective alternative.

Just wanted to point out that this is one of the main problems addressed by the article. Doctors and hospitals get away with this because the patients aren't the ones paying for it. If you had to pay out of pocket for routine care, you would flip your wig at your doctor for ordering 300.00 of unneccesary testing just to pad his wallet.

[The Space Pope]

Just wanted to point out that this is one of the main problems addressed by the article. Doctors and hospitals get away with this because the patients aren't the ones paying for it. If you had to pay out of pocket for routine care, you would flip your wig at your doctor for ordering 300.00 of unneccesary testing just to pad his wallet.

You would also avoid going for care in the first place. Which is why the articles suggestions are a bad idea.

[Lord Mord]

That's one of my main gripes about anarchy ... is that it basically leaves the individual consumer so totally to their own devices that they must become experts on nearly everything. What do I know if that $300.00 test is necessary or not? I went to medical school?

[Nymeria Sand]

You would also avoid going for care in the first place. Which is why the articles suggestions are a bad idea.

Under the current system, the doctor gets paid for having you as a patient whether you go to see him/her or not. Just for being enrolled in a HMO/PPO/whatever. And then when you actually go see them, they get paid again.

[Lord Mord]

Nymeria,

Under the current system, the doctor gets paid for having you as a patient whether you go to see him/her or not. Just for being enrolled in a HMO/PPO/whatever. And then when you actually go see them, they get paid again.

That's interesting. Is there something more to this, or are you strictly sharing knowledge?

[Tormund Ukrainesbane]

You would also avoid going for care in the first place. Which is why the articles suggestions are a bad idea.

Or you would go to a different doctor, and obtain a different price. You would likely demand an upfront estimate of costs, as you do for every other good and service in the world.

That's one of my main gripes about anarchy ... is that it basically leaves the individual consumer so totally to their own devices that they must become experts on nearly everything. What do I know if that $300.00 test is necessary or not? I went to medical school?

How do you know how much you should pay for a new transmission? Are you a mechanic? How do you know if 79 cents a pound is a good price for bananas? Are you a farmer? Seriously, health care is a consumer good, just like all others. How do you know how much to pay for anything?

[Dumas]

How do you know how much you should pay for a new transmission? Are you a mechanic? How do you know if 79 cents a pound is a good price for bananas? Are you a farmer? Seriously, health care is a consumer good, just like all others. How do you know how much to pay for anything?

Health care, unfortunately, is not very similar to bananas. For material goods, particularly ones sold by many providers, it is very simple to compare prices and quality, at least for simple and common ones. Health care, being based on expertise and knowledge, is not as simple for the average consumer to compare. Going for a second opinion costs more than driving across town to check banana prices at multiple stores.

In addition, the number of sources for health care and the volume available (and transmissions and more complex items in general) is relatively low. This gives the providers more leverage to keep prices at a certain level and the consumer is left with little power to negotiate or ability to find lower prices. If a limited number of labs is doing tests for a large number of doctors, this only increases the imbalance.

And the question there is not whether the price is too high or too low, but whether the good is desired or needed at all. Evaluating the need for a new transmission or the desire for a banana is a simple and straightforward decision. There is no good substitute for a functioning transmission in your car and perhaps few that would be compatible with your model, and not that many for a banana if you want to eat one. Knowledge of alternative tests, what the test is actually looking for and how it relates to your signs and symptoms, perhaps the range of conditions that may account for those symptoms; these are just the basics of what a consumer would to know to decide whether the test needs to be performed. Only after that can he even consider price.

[The Space Pope]

Or you would go to a different doctor, and obtain a different price. You would likely demand an upfront estimate of costs, as you do for every other good and service in the world.

That doesn't solve anything. You are still paying for it in the first place.

By forcing people to research and directly pay for their own care, you are discouraging them from seeking care by adding barriers.

This hampers preventative care and preventative care is what you want to push more then anything. It lets you deal with problems better and cheaper.

How do you know how much you should pay for a new transmission? Are you a mechanic? How do you know if 79 cents a pound is a good price for bananas? Are you a farmer? Seriously, health care is a consumer good, just like all others. How do you know how much to pay for anything?

Again, your seriously saying "It's just like getting your car fixed" and pretending this is a GOOD thing?

How many people bitch about mechanics or home contractors ripping them off for things they don't need or aren't sure they need?

(ps - the answer is "ALOT")

Also, all of what Dumas says above.

[Tormund Ukrainesbane]

Health care, being based on expertise and knowledge, is not as simple for the average consumer to compare. Going for a second opinion costs more than driving across town to check banana prices at multiple stores.

Same with stock brokers, pool cleaning services, realtors, and computer salesmen.

Health care is not a unique snowflake

In addition, the number of sources for health care and the volume available (and transmissions and more complex items in general) is relatively low. This gives the providers more leverage to keep prices at a certain level and the consumer is left with little power to negotiate or ability to find lower prices. If a limited number of labs is doing tests for a large number of doctors, this only increases the imbalance.

As the article points out, this is by design. Health care providers lobby fiercly to keep competition out.

That doesn't solve anything. You are still paying for it in the first place.

Who the hell else is supposed to? You're paying for it one way or the other, how is it helpful to pay 300.00/mo to an insurance company so that you will only have a 10.00 co-pay for a 100.00 doctor visit twice a year? Doesn't it make a lot more sense to pay 75.00 twice a year for the doctor visit, and 150.00/mo to insure against catastrophe?

By forcing people to research and directly pay for their own care, you are discouraging them from seeking care by adding barriers.

How do we know this? The possibility of having to buy a new engine encourages me to make sure my oil gets changed and my timing belt gets replaced. The possibility of a wreck encourages me to replace my tires, even though I KNOW my insurance will cover a wreck.

How many people bitch about mechanics or home contractors ripping them off for things they don't need or aren't sure they need?

How many people accept the fact that your car is going to break down and they will have to pay for it? (ps- the answer is ALL OF THEM)

[Security Squish]

Or you would go to a different doctor, and obtain a different price. You would likely demand an upfront estimate of costs, as you do for every other good and service in the world.

How do you know how much you should pay for a new transmission? Are you a mechanic? How do you know if 79 cents a pound is a good price for bananas? Are you a farmer? Seriously, health care is a consumer good, just like all others. How do you know how much to pay for anything?

You have abdominal pain, it hurts like hell you you drive on a bumpy road, you have been nauseous since you woke up in the morning. You may have a slight fever, but your blood preasure is good, your have no trouble breathing, or any other real distress at this time. What tests do you need done?

[The Space Pope]

Who the hell else is supposed to? You're paying for it one way or the other, how is it helpful to pay 300.00/mo to an insurance company so that you will only have a 10.00 co-pay for a 100.00 doctor visit twice a year? Doesn't it make a lot more sense to pay 75.00 twice a year for the doctor visit, and 150.00/mo to insure against catastrophe?

Of course you're paying for it in the end. But HOW you are paying for it is very important in how people treat and use the service.

The less people feel like they are paying for the service directly, the more they feel like it' "free". The more they feel like it's free, the more they will use it. THIS IS A GOOD THING. You want people to be getting regular checkups more.

And the thing is, you don't need to hide prices to do this. The Swiss System, for instance, runs off private insurance (with plan's minimum standards being defined by the government) while still forcing doctors to advertise their prices publicly. This means people both know how much they are paying for what and yet aren't paying it directly (since their insurance is the one footing he actual bill).

You don't need to force people to pay directly for their care to make prices public.

How do we know this? The possibility of having to buy a new engine encourages me to make sure my oil gets changed and my timing belt gets replaced. The possibility of a wreck encourages me to replace my tires, even though I KNOW my insurance will cover a wreck.

And yet people drive around in cars rusting to pieces and don't change their oil on time and a hundred other terrible things to their cars rather then doing some simple cheap maintenance to prevent it, because they are too lazy to do it themselves and/or don't feel like paying for it and/or don't even know it needs to be done. Because they don't see the long term benefits and don't know any better.

Peoples health is the same. "I've got a bad cough. But going to the doctor? Ugh, it costs so much money and time".

The more barriers you on people seeking care (and forcing them to pay directly for a doctor's visit is a big barrier) then more they will put it off or ignore it or tough it out. Until that little cheap problem because a big expensive problem. And not just expensive for them.

How many people accept the fact that your car is going to break down and they will have to pay for it? (ps- the answer is ALL OF THEM)

What's this got to do with anything?

Saying "Doctors should be more like Mechanics" is laughable since people don't like the way mechanics are right now.

[Tormund Ukrainesbane]

You have abdominal pain, it hurts like hell you you drive on a bumpy road, you have been nauseous since you woke up in the morning. You may have a slight fever, but your blood preasure is good, your have no trouble breathing, or any other real distress at this time. What tests do you need done?

:rolleyes:

Your engine is making a rattling noise and some wierd blinkly lights are going on your dash. What's wrong with your car?

Your stock portfolio was 10000.00 last week, 3000.00 yesterday, and 15000.00 today. What do you need to sell or buy to stabilize your portfolio?

Remember: your mechanic is getting fired, and maybe sued if he overcharges you. Your stockbroker too. Your doctor, on the other hand, is incentivized to do so, and faces no consequence should he be found out. The only one who pays for his actions is all of us.

ETA:

And yet people drive around in cars rusting to pieces and don't change their oil on time and a hundred other terrible things to their cars rather then doing some simple cheap maintenance to prevent it, because they are too lazy to do it themselves and/or don't feel like paying for it and/or don't even know it needs to be done. Because they don't see the long term benefits and don't know any better.

And the system you propose would require that the rest of us pay for it, because they were too lazy/cheap/dumb. Sounds great, I can't wait!

[Security Squish]

:rolleyes:

Your engine is making a rattling noise and some wierd blinkly lights are going on your dash. What's wrong with your car?

Your stock portfolio was 10000.00 last week, 3000.00 yesterday, and 15000.00 today. What do you need to sell or buy to stabilize your portfolio?

Remember: your mechanic is getting fired, and maybe sued if he overcharges you. Your stockbroker too. Your doctor, on the other hand, is incentivized to do so, and faces no consequence should he be found out. The only one who pays for his actions is all of us.

Your reminder is not always true. I don't know crap about cars so I could get overcharged easily, no firings or suings. Also my hospital would reprimand or remove a doctor who orderd too many extra tests. I personally would probably stop them. My point is only that people don't know how medicine works, don;t kane good decisions when ill, don't have time to shop around if seriously ill, and can harm themselves by denying treatment in a timely manner.

People refuse tests right now due to not liking what it will cost. Some of these people save money, some get more ill, some die. It's really not the same gamble as with cars. You can also sue the crap out of docotrs. My understanding is that it happens a lot and for too much money.

[The Space Pope]

Shit, just watch Holmes on Homes for a good picture of what happens when people are forced to make big decisions about life altering shit having to do with a field they know nothing about.

The answer: they get screwed over.

EDIT:

And the system you propose would require that the rest of us pay for it, because they were too lazy/cheap/dumb. Sounds great, I can't wait!

You pay for them anyway. You pay when they go to the ER. You pay when they go bankrupt. You pay when they are forced onto sick leave. You pay when they lose their job.

You always pay for the people around you.

[Bellis]

Tormund -

You could choose not to get your car fixed right away. You leave it at the side of the road and take a cab, bus, get your buddy to give you a ride. You won't die if you don't have a car for a couple days.

You could gather information about your stocks and decide what to do. Sure, you might lose money versus acting right away, but you won't die if you wait.

You have severe chest or stomach pains - you're more likely talking about a matter of life or death.

[The Progressive]

The sort of healthcare "reform" where the government programs are replaced entirely by the private sector would only make economic sense only if there's no mandate that hospitals must treat people regardless of their ability to pay. It would be a cruel system in which poor people will be denied care and treatment if such services were to exceed their ability to pay ........... but it would work.

Nonetheless, if you're unlucky enough to be severely ill due to some catastrophic accidents, genetic/environmental diseases, or if your family members are .............. chances are good that the insurance companies will try to deny coverage if it becomes too costly. They have an army of attorneys and accountants, you have yourself and if luckily some underpaid/overwork nonprofit consumer groups fighting for you.

About the article ................... after several threads in which the failure of the private system were dissected to microscopic pieces and the lies debunked, yet you still managed to link to a shrill piece for even more privatization of healthcare? I'm disappointed in you JaimeL.

[Iskaral Pust]

Jaime - I think you are overstating it a bit, here. Why don't you look at your own billing rate? Clients actually pay that, you know. Are you really worth $300 an hour, or whatever it is that tax managers in DC at the firm are billing? Maybe you think the partners at the firm really are worth $900 an hour?

Is that any less lucridious than my LASIK fee being $5,000? Or an (calculated from procedures) hour of my plastic surgeon's time in surgery being $1,500 an hour?

I would say "no". I would also say that you do get what you pay for, and the consumer will pay more for perceived value; whether it's having a Big 4 tax partner vs a small firm tax partner, or me willingly shelling out $5,000 for the "best" LASIK doc vs some $499 chop shop.

That's not a bad analogy (I'm at $700+ per hour myself), but that billing rate applies to all clients. Doctors use BS billing rates that are an acknowledged fiction of the reimbursement game. For example, a hospital might quote you a fee in the region of $30k for child-birth including two nights stay in a private room and the standard tests and care (extra for longer stay, special tests, C-section, etc). So anyone without insurance will have to pay that price. Anyone with insurance will have a significantly lower price paid on their behalf by the insurance company. The non-insured get to pay suckers' prices because they don't have the data or bargaining power to pay the real price. And the margin for uninformed suckers is really, really high. My employer includes a huge health consulting business, I am not completely uninformed on this (there are health actuaries, and even pension actuaries like me work on retiree medical obligations).

It's just like you should never pay full retail price for anything at a mall jewellry store. But at least there you can see what the discounts are in the never-ending sales events. With health-care, the uninsured patient never sees the price quoted to the insurance company.

The health care industry is not conducive to smart consumerism for other reasons. LASIK is a good example. Costs have come down due to competition and market forces, but every consumer is faced with an impossible choice: do they risk their eye-sight on the cheapest offer advertised on the side of a bus, or do they pay for the most expensive in the hopes that price implies quality? Even if you research all the statistics for that procedure, you're still guessing at the value exchange. And there is no way you can research each and every moment of health care use in advance.

We do need to end the practice of people blindly spending "other people's money" on health care, but the health care providers would first need to quote honest prices. Health consumerism will be important, but there is a lot of transparency needed first.

And I agree with Lev that you can't make health care a fully privatized sector so long as there is a mandate to provide treatment. Pure consumer choice in a free market has no room for social necessity.