U.S. Hospitals - too expensive?

[mongers]

That's rich. A lawyer bitching about fees. The resident emergency department physician who put in that stitch in is getting paid around $11 an hour.

That's waht I was also kind of taking away from the article - that only a fraction of the charged prices cover the actual procedure and materials, and the rest is for the ginormous overhead/less profitable stuff, not all of which may be necessary for the hospital to do its core job of helping people get better.

Someone has to pay for all of that gas station food.

[KRonn]

Outside of the crazy stories and inefficiency of hospital billing, I think also some of the higher costs are due to providers and hospitals charging more to insured patients to help defray costs for Medicaid and Medicare patients, which the government reimburses at a much lesser rate resulting in a loss. Providers charge insurance companies more for insured patients, in part to pay for the free care of other patients, which of course results in higher premiums for insured people and companies paying employee insurance. I wonder how much affect it has on the medical system, hospitals and insurers, or if instead it's not a big factor.

[Valmy]

Yes they are crazy high.  But why wouldn't they be?  Why not charge as much as the market will bear and you have a captive customer base so...

[Valmy]

Outside of the crazy stories and inefficiency of hospital billing, I think also some of the higher costs are due to providers and hospitals charging more to insured patients to help defray costs for Medicaid and Medicare patients, which the government reimburses at a much lesser rate resulting in a loss. Providers charge insurance companies more for insured patients, in part to pay for the free care of other patients, which of course results in higher premiums for insured people and companies paying employee insurance. I wonder how much affect it has on the medical system, hospitals and insurers, or if instead it's not a big factor.

There are multitudes of factors, as it is very complicated.  But pricing can be complicated in any industry.  Ultimately though they CAN charge this much so they will.  Without market forces to pressure companies to lower prices that is what will happen.

[Barrister]

As Hospital Prices Soar, a Stitch Tops $500

....

Daniel Diaz, who had been treated at Lenox Hill, Mr. Roberts and Amy Bernstein had no choice but to visit an emergency room this year for stitches. But they all refused to see a doctor for the follow-up.

"The amount was outrageous for the time it took to put them in," said Ms. Bernstein, 54, a real estate lawyer from Long Island, who cut herself cleaning knives while fixing a kitchen damaged by Hurricane Sandy. "I was so disgusted, I took them out myself."

That's rich. A lawyer bitching about fees. The resident emergency department physician who put in that stitch is getting paid around $11 an hour, and provides a hell of a lot more good for society.

And you of course realize that even if that lawyer is billing $200 per hour (and, by the way, whenever I have to hire a lawyer for court they charge a lot more than that) the lawyer is only taking home a fraction of that amount?

[Iormlund]

We really need an NHS. It's too late for anything else; Just nationalize everything.

You don't have to nationalize "everything".  The Canadian model, for example, still has privately run hospitals and clinics.  It's just that there is only one insurer - the national government.

How do you deal with perverse incentives?

[Barrister]

We really need an NHS. It's too late for anything else; Just nationalize everything.

You don't have to nationalize "everything".  The Canadian model, for example, still has privately run hospitals and clinics.  It's just that there is only one insurer - the national government.

How do you deal with perverse incentives?

Poorly.

I thought about going back and pointing out I'm not a big fan of the Canadian health care system, but decided to just let it lie.

The troubles are that the government then sets (or negotiates) the pay rates for a whole variety of procedures.  Doctors are paid per procedure, not for time worked.  As such they have incentive to pack in as many patients in a day as possible.  As well there are few disincentives to not order a whole battery of tests or procedures.

The government also sets out what procedures will, and will not, be covered (and this is what gets called Death Panels in the US).  But politicians of course are susceptible to political pressure, and it is tough to de-list a procedure even if it's effectiveness is questionable.

[Iormlund]

The Death Panel thing is unavoidable, really. We obviously have one as well (maybe several, since healthcare is now under regional governments).


There is a strong drive from our politicians, especially Populares, to set up a Canadian-style system here. At 15% of the budget, there is a lot of money to be made from handing healthcare to private companies like Capio, now that kickbacks from construction have dried up.

[The Minsky Moment]

The government also sets out what procedures will, and will not, be covered (and this is what gets called Death Panels in the US). 

The Death Panel thing in the US was about something different.  There was a provision in one of the Obamacare bills permitting reimbursement to terminally ill patients for end-of-life care counseling sessions.  It had nothing to do with scope of coverage decisions.  if kept in the bill it would have actually expanded the scope of covered services.

[Admiral Yi]

The Death Panel thing in the US was about something different.  There was a provision in one of the Obamacare bills permitting reimbursement to terminally ill patients for end-of-life care counseling sessions.  It had nothing to do with scope of coverage decisions.  if kept in the bill it would have actually expanded the scope of covered services.

Actually I believe it was a smidge more sinister than that; doctors were to receive a bonus for each end of life session they conducted.

[11B4V]

The Death Panel thing in the US was about something different.  There was a provision in one of the Obamacare bills permitting reimbursement to terminally ill patients for end-of-life care counseling sessions.  It had nothing to do with scope of coverage decisions.  if kept in the bill it would have actually expanded the scope of covered services.

Actually I believe it was a smidge more sinister than that; doctors were to receive a bonus for each end of life session they conducted.

No, no conflict there. 

[The Minsky Moment]

The Death Panel thing in the US was about something different.  There was a provision in one of the Obamacare bills permitting reimbursement to terminally ill patients for end-of-life care counseling sessions.  It had nothing to do with scope of coverage decisions.  if kept in the bill it would have actually expanded the scope of covered services.

Actually I believe it was a smidge more sinister than that; doctors were to receive a bonus for each end of life session they conducted.

I don't see that in the proposed text:  http://www.politico.com/pdf/PPM130_1233.pdf
It just includes advanced care planning consultations in the definition of medical services reimbursable under Medicare
There is a section for quality reporting but that hardly translates into the kind of bonus system you are talking about.

The other thing to keep in mind is that the consultations were supposed to be there to permit people to make orders FOR life sustaining treatment as well.  It could just as well be called Life Panels (if in fact any kind of panel was being contemplated, which it was not).

[celedhring]

Still remember when I lived in NYC and I developed a pain in the ear. Went to the doctor and - somehow - left with a couple of blood extractions for testing before ultimately being diagnosed a harmless otitis. My insurance picked up the tab, but that looked to me as just a way to inflate the bill for no real medical purpose.

[CountDeMoney]

The Death Panel thing in the US was about something different.  There was a provision in one of the Obamacare bills permitting reimbursement to terminally ill patients for end-of-life care counseling sessions.  It had nothing to do with scope of coverage decisions.  if kept in the bill it would have actually expanded the scope of covered services.

Actually I believe it was a smidge more sinister than that; doctors were to receive a bonus for each end of life session they conducted.

No, no conflict there. 

That was to offset their losses from not being able to pad their bills for keeping vegetables alive for another 6 useless months. 
We have medical school loans to worry about;  those vegetables don't bill themselves, you know.

[Josquius]

We really need an NHS. It's too late for anything else; Just nationalize everything.

You don't have to nationalize "everything".  The Canadian model, for example, still has privately run hospitals and clinics.  It's just that there is only one insurer - the national government.

That sounds potentially inefficient though, won't they still charge crazy prices only this time its the government paying the bill?