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kallend

Why medical bills are so high

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Allow me to explain the economics of health care policy. This is not just in the US but worldwide.

There are three factors that go into what people want for health care policy: (1) Inexpensive; (2) High quality; and (3) Available on demand. Problem is you can’t have all three of them.



Total BS. The Vet community does it all the time. Allow Doctors to practice their art without all of the other morons telling them how to do it and amazing things would happen.



Not quite sure what you are trying to say, but when was the last time you went to a military medical facility and all those things were available at the same time?

That used to be true for the military and their families, but, sadly no longer is.
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I could come up with hundreds of billions of dollars (maybe a trillion) of savings to healthcare with one policy change in medicare.

Out of curiosity, what would that policy change be?

Don



There are many times in orthopaedics that I have to implant hardware into somebody. This could be plates, screws, or pins for fracture care. This could be a prosthesis for a joint replacement. There are special implants that you use for arthroscopic rotator cuff repair. If I have a Medicare patient that needs an implant, I am pretty much forced to perform that procedure in the hospital setting as opposed to a surgery center. The reason I am forced to do so is that Medicare does not reimburse the cost of the implant to a surgery center, but will reimburse the cost to the hospital. The margins are such that the surgery center will not be profitable if they had to eat the cost of the implant. Here is the kicker: Operating room charges to Medicare are about 4x the amount as surgery centers. If you have a total knee done at a hospital, the total cost will probably be around 80k. Total cost at a surgery center will be about 20k. If Medicare would reimburse implants to surgery centers like hospitals, the savings to the tax payer would be enormous. It really does not have much to do about saving money. IMO is has more to do about lobbying. Hence my previous comments that the political system is broken. The real solution is term limits.

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It's not very long.



No, I was referring to your video.



I know.

I hate having to paraphrase something I really didn't watch all that carefully and am not certain whether or not I agree with.

The basic point I got from it was that hospitals have a monopoly on health care so they take advantage and charge what ever they want, along with pushing small doctors out of business.

I only watched it once. It's not an issue that I really care about too much. Nothing I can do about the rising health care costs and I think ACA will make it more expensive, not less.

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Basically the video reinforces my previous post about the cost difference between hospital surgery and surgery centers. It is pretty short. I really do not disagree with anything the video states. He does mention one sentenced that is glossed over and is very important. Currently doctors are leaving their well established private practices and are being employed by hospitals in response to ACA. This drives the cost of healthcare UP significantly. I can explain if you want.

As I mentioned previously, the ACA is not really about healthcare at all and it will only hasten its demise.

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I only watched it once. It's not an issue that I really care about too much. Nothing I can do about the rising health care costs and I think ACA will make it more expensive, not less.



Rising health care costs should be something that everybody should care about and become educated. It is a massive cost and will bankrupt this country.

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I don't disagree. The US is practically bankrupt already. ..



Funny, don't you think, that people and institutions are still willing to lend us money at these absurdly low interest rates.

Or maybe you're just wrong.
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The only sure way to survive a canopy collision is not to have one.

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first of all, most of the cost rise associated with medical bills has to do with malpractice insurance, the higher cost of education,



No.

1. Malpractice insurance constitutes less than 2% of health care spending.

2. Physician's salaries which ultimately pay for doctors' university training are only 5-10% of medical spending.

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and advertising.



Nope. Advertising only works because the returns are a lot greater than the spending.

For instance drug companies need to convince consumers to pester their doctors for new drugs which are still covered by patent and expensive instead of old generic ones that are less profitable due to competition.

My favorite is the Prilosec story. Prilosec had $5.6B in annual sales in 2001 which was the last full year it was covered by patent. The poor drug company expected to loose 85% of the market to generics. They got rid of the significantly less bioactive chiral form of the active ingredient, patented the single chiral form, called it Nexium, and ran a great marketing campaign. Prilosec + Nexium annual sales combined went from $6.1B in 2001 to $6.6B in 2002.

Much of the increase comes from improved technology; although the improvements (single chiral forms of old drugs) can be better for profits than patients and there's a lot of over treatment going on.

Health care is expensive in America because it's corporatist not capitalist (where it's reasonable for consumers to choose less expensive alternatives) or socialist (where no profit motive keeps costs down).

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I don't disagree. The US is practically bankrupt already. ..



Funny, don't you think, that people and institutions are still willing to lend us money at these absurdly low interest rates.

Or maybe you're just wrong.



Just because the US can borrow at low interest rates doesn't mean it's a good idea and doesn't mean it will last forever. Also it's no indication of the ability of the US to repay the debt. The Fed is currently monitiziing the debt and there is no way for them to unwind their balance sheet with out causing problems.

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So, Man Vs. Mutt. Who gets better health care? Here is an article I remember reading back when Obamacare was being considered:
http://online.wsj.com/article/SB10001424052970204908604574334282143887974.html
"There is an art, it says, or, rather, a knack to flying. The knack lies in learning how to throw yourself at the ground and miss."
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first of all, most of the cost rise associated with medical bills has to do with malpractice insurance, the higher cost of education, and advertising. it's just like a lawyer to think that it's ok for someone to pay a 400% markup on something just because the government is given a discount.
as to the cost going down in ma, i would assume (having not looked at any figures here) that it was because people could actually get treated now, so the relative decrease in the cost was offset by increasing treatment.



My fiancee is a physician, and while her malpractice premiums are more than I pay to insure my airplane, house and car combined, they are still just a small fraction of her income.

In both my (and her) opinion the problem is simply price gouging and inefficiency in hospitals and insurance companies.
...

The only sure way to survive a canopy collision is not to have one.

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So a vet never has a discussion with a pet owner that "rover can have an operation to remove the intestinal blockage. That'll be $xxxxx. Or we can put rover to sleep.". If you say yes I call bullshit. Because I've had that discussion. Access - quality - expense.

Yep - health care for pets includes euthanasia. With humans that's usually not considerwd quality.


My wife is hotter than your wife.

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Been there done that, "rover" looked so much better after the IV fluids/whatever else was in there that we decided to wait and see. Passed the rubber "super ball" the next day on his own, "rover" happy and healthy, bank account only minorly drained and kid still has dog, although no longer allowed "super balls". Everyone pretty much happy with outcome, although I doubt we'd have made the same call if it was Grandma instead of Bo.

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Been there done that, "rover" looked so much better after the IV fluids/whatever else was in there that we decided to wait and see. Passed the rubber "super ball" the next day on his own, "rover" happy and healthy, bank account only minorly drained and kid still has dog, although no longer allowed "super balls". Everyone pretty much happy with outcome, although I doubt we'd have made the same call if it was Grandma instead of Bo.



So you'd euthanize the poor lady to after all she's done for the family?
I don't get some people.

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Yep - health care for pets includes euthanasia. With humans that's usually not considerwd quality.


Compared to being a vegetable lying in a hospital bed while the meter runs, euthanasia would be better "quality".
My reality and yours are quite different.
I think we're all Bozos on this bus.
Falcon5232, SCS8170, SCSA353, POPS9398, DS239

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I haven't yet seen anyone mention what the article details -- the income of the highest leadership at some of these expensive hospitals. While I concede that expertise and skills (such as an experienced surgeon or CFO) do come at a cost, I was personally shocked to see the seven-figure salaries listed.

I'm curious (yes, I really want to know -- this isn't rhetorical), are they really worth that salary, and do they really stand to bear the financial burden if the institution is hit with a major lawsuit? Mostly, I was shocked more by the fact that the hospital administrator makes so much more than the university administrator to which the hospital is associated.

I don't disagree that the providers farther down the ladder bear an enormous risk (malpractice suits, for example), and that the institution itself should be able to fend off frivolous suits (or pay out legitimate ones). Financial compensation in those cases makes sense to me. It's the top seven individuals each taking home seven figures, that sounds off to me.

The other question I have revolves around what the article cites as the cost charged for glucose test strips, generic Tylenol, alcohol swabs and gauze pads. What would happen if you went in for your hospital stay with your own, unopened (fresh from the drugstore) stock of these items?


and.... discuss.
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