http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html?smid=fb-nytimes&WT.z_sma=HL_AHP_20131203
QuoteAs Hospital Prices Soar, a Stitch Tops $500
SAN FRANCISCO — With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center's tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.
On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. "It was great — they had good DVDs, the staff couldn't have been nicer," said Emer Duffy, Orla's mother.
Then the bills arrived. Ms. Singh's three stitches cost $2,229.11. Orla's forehead was sealed with a dab of skin glue for $1,696. "When I first saw the charge, I said, 'What could possibly have cost that much?' " recalled Ms. Singh. "They billed for everything, every pill."
In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.
A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.
At Lenox Hill Hospital in New York City, Daniel Diaz, 29, a public relations executive, was billed $3,355.96 for five stitches on his finger after cutting himself while peeling an avocado. At a hospital in Jacksonville, Fla., Arch Roberts Jr., 56, a former government employee, was charged more than $2,000 for three stitches after being bitten by a dog. At Mercy Hospital in Port Huron, Mich., Chelsea Manning, 22, a student, received bills for close to $3,000 for six stitches after she tripped running up a path. Insurers and patients negotiated lower prices, but those charges were a starting point.
The main reason for high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a health care system that has little or no price regulation in the private market.
Rising costs of drugs, medical equipment and other services, and fees from layers of middlemen, play a significant role in escalating hospital bills, of course. But just as important is that mergers and consolidation have resulted in a couple of hospital chains — like Partners in Boston, or Banner in Phoenix — dominating many parts of the country, allowing them to command high prices from insurers and employers.
Sutter Health, California Pacific Medical Center's parent company, operates more than two dozen community hospitals in Northern California, almost all in middle-class or high-income neighborhoods. Its clout has helped California Pacific Medical Center, the state's largest private nonprofit hospital, also earn the highest net income in California. Prices for many of the procedures at the San Francisco hospital are among the top 20 percent in the country, according to a New York Times analysis of data released by the federal government.
"Sutter is a leader — a pioneer — in figuring out how to amass market power to raise prices and decrease competition," said Glenn Melnick, a professor of health economics at the University of Southern California. "How do hospitals set prices? They set prices to maximize revenue, and they raise prices as much as they can — all the research supports that."
In other countries, the price of a day in the hospital often includes many basic services. Not here. The "chargemaster," the price list created by each hospital, typically has more than ten thousand entries, and almost nothing — even an aspirin, a bag of IV fluid, or a visit from a physical therapist to help a patient get out of bed — is free. Those lists are usually secret, but California requires them to be filed with health regulators and disclosed.
California Pacific Medical Center's 400-page chargemaster for this year contains some eye-popping figures: from $32,901 for an X-ray study of the heart's arteries to $25,646.88 for gall bladder removal (doctor's fees not included) to $5,510 for a simple vaginal delivery (not including $731 for each hour of labor, or $137 for each bag of IV fluid). Even basic supplies or services carry huge markups: $20 for a codeine pill (50 cents at Rite-Aid or Walgreens), $543 for a breast-pump kit ($25 online), $4,495 for a CT scan of the abdomen (about $400 at an outpatient facility nearby). Plenty of other hospitals set similar prices.
Dr. Warren Browner, the chief executive officer of California Pacific Medical Center, said that there were good reasons that hospitals charged what they did: They must have highly trained professionals available 24 hours a day, seven days a week. They must constantly upgrade to the latest equipment and building standards to meet patients' expectations and state mandates. They charge paying or well-insured patients more to compensate for others they treat at a loss.
"Hospital care is extremely expensive to produce and to have available for everyone in the community," he said, noting that hospitals needed to have a neurosurgeon on call in case a patient turned up with a blood clot on the brain. "We take every penny of the revenue we earn and use it to build new and better facilities for everyone in the city."
Some health economists say that even though most hospitals are nonprofit, they nonetheless are often flush with revenue and guilty of unnecessary spending.
"Hospitals are self-fueling, ever-expanding machines," said James Robinson, an economist and professor of health policy at the University of California, Berkeley. "There is an infinite amount of stuff to buy — amenities, machines, new wings, higher salaries, more nurses."
"But," he asked, "to deliver good health care, what do you need?"
Few Constraints
There is little science to how hospitals determine the prices they print on hospital bills.
"Chargemaster prices are basically arbitrary, not connected to underlying costs or market prices," said Professor Melnick, the economist. Hospitals "can set them at any level they want. There are no market constraints."
Prices for any item or service are set by each hospital and move up and down yearly, and show extraordinary variability, health economists say. The codeine that costs $20 and the bag of IV fluid that costs $137 at California Pacific are charged at $1 and $16 at the University of California San Francisco Medical Center, across town. But U.C.S.F. Medical Center charges $1,600 for an amniocentesis, which costs $687 at California Pacific.
After each hospital stay or visit, computer programs and human coders and billers use the chargemaster price list to translate the services rendered into a price. Sutter employs more than 1,300 people at a special center in Roseville, Calif., to perform this and other administrative tasks for its hospitals. Emergency room visits typically include separate charges for doctor's services and for supplies, as well as a "facility fee" — the charge for walking in the door.
Orla Roche's bill, for example, included $529 for "supplies and devices," though her mother is perplexed about what those are: Orla left the emergency room with gauze wrapped round her head (under $1 at Internet supply stores), festooned with a pink cartoon sticker. According to the chargemaster price list for California Pacific, a vial of skin glue is billed at $181, a tube of antibiotic cream at $125.84 and a vial of local anesthetic at $79.73. These items can be purchased for $15.99, $36.99 and $5 on the Internet, though hospitals — which buy wholesale and in bulk — pay far less.
The bill also included $1,167 for the facility fee, which was classified at Level 3 — the middle of the scale, though Orla's treatment was one of the most simple emergency room interventions. At Lenox Hill in New York, Daniel Diaz's unusually detailed bill for his stitches included $1,828 for emergency room services, $628 for repairing the wound, $571.83 for "application of a finger splint," $97.10 for a tetanus shot, and $311 for someone to give the injection. At Sparrow Hospital in Lansing, Mich., 2-year-old Ben Bellar's bill for six stitches, more than $2,000, included $145.20 for "pharmacy" — a spoonful of ibuprofen and local anesthetic, his mother said.
Economists note that hospitals can bill for emergency room care with relative impunity, since injured patients generally rush to the nearest treatment facility. But worried about high prices, even the sick sometimes shop around. When Jamie Burke, 33, a graduate student in North Carolina, came to after she was knocked out during a soccer game in April, she started searching on her smartphone for an in-network hospital as a friend drove.
"It was crazy," she said, "but luckily I wasn't unconscious, so I could figure it out."
She is glad she did: Though the hospital billed $5,039, her insurer's in-network contracted rate was about $2,700. With copays and coinsurance, she owed $600 for the visit.The uninsured are particularly vulnerable to high prices since they have no one to argue on their behalf. When Arch Roberts Jr. got his bill of more than $2,000 for stitches, he explained that he was uninsured and his business had failed during the housing crisis, so he could not afford the fee. The hospital offered him a "charity care discount" — a price that was still out of range. "I don't have $800 to pay them any more than I have $2,000" for three stitches, he said, noting that the hospital has been "relentless" in its collection efforts.
Paths to Profit
Once perennial money pits, emergency rooms have become big moneymakers for most hospitals in the last decade, experts say, as they raised their fees and "managed" their patient mix. California Pacific Medical Center has nearly doubled its emergency room fees since 2005, its chargemaster price lists show.
California Pacific's emergency room is not a trauma center; poor or uninsured trauma patients who require lengthy inpatient stays can strain a hospital budget. And insurers allow emergency rooms to bill more than urgent-care centers for simple procedures like stitches or X-raying a sprained ankle, making such procedures profitable. Indeed, the financial prospects are so appealing that doctors' groups in Texas are opening free-standing "emergency rooms" that are not connected to hospitals.
"Hospitals see where they're making money and try to do more of that," said Dr. David Gifford, a former health commissioner of Rhode Island, who has studied how labs price their tests. He said that laboratory tests and X-rays are priced high and are profitable, though there is no difference in quality from national commercial labs that charge far less. A blood count and blood electrolyte test — ordered every day for most inpatients and often in the emergency room — are priced at $259.06 and $293.25 on California Pacific Medical Center's chargemaster price list. Insurers often pay outside labs less than $10 for the services.
And, like any business, many hospitals try to do fewer services that are not well paid. In 2012, over loud patient protests, California Pacific Medical Center outsourced its kidney dialysis unit to DaVita Health Care Partners, a commercial company, citing decreasing reimbursement. More than five years ago, after Sutter acquired St. Luke's, a decrepit hospital in a poor neighborhood, it tried to shut the facility and convert it to an outpatient clinic, which often generate scans and other expensive tests. (The City of San Francisco rejected the plan.) It did close the hospital's acute psychiatric unit, a division that almost always loses money.
"You need a Ph.D. in health economics" to understand medical pricing, said Dr. Browner, who has acknowledged that California Pacific's chargemaster prices might appear high. But he added, "We have to recoup what it costs to keep open, what it costs to take care of the un- and underinsured and to rebuild."
He said that MediCal, California's Medicaid program, pays California Pacific Medical Center only 10 to 20 percent of its actual costs for care. Medicare pays about 70 percent, he said, generally with a predetermined flat fee for each admission based on the patient's diagnosis. In contrast, many private insurers still pay separately for services rendered, based on discounts from the chargemaster prices.
Dr. Browner also pointed to what health care executives call the "Saudi sheikh problem" at some hospitals.
"You don't really want to change your charges if you have a Saudi sheikh come in with a suitcase full of cash who's going to pay full charges," he said.
But how much actual charity care does a hospital like California Pacific Medical Center perform? And are insurers and patients paying hospitals for better quality? Or also for amenities like valet parking, useless medical gadgetry and inflated salaries?
Though hospitals' nonprofit status allows them to reap tens or hundreds of millions of dollars in tax benefits, California Pacific Medical Center's main campuses spent 1.27 percent of their more than $1.1 billion in net patient revenues in 2011 on free care for indigent or uninsured patients, lower than the state average of 2.07 percent, according to statistics compiled by the San Francisco Department of Public Health. The far smaller St. Luke's branch spent 5.32 percent that year.
Sutter, based in Sacramento, employs 28 officials who make more than $1 million a year, and four of them are among the top-paid hospital executives in the state. Sutter's chief executive officer makes more than $5 million. In 2011, Dr. Browner, 62, a distinguished physician who spent much of his career in academics, made more than $1.2 million, according to tax documents.
California Pacific, Sutter's main campus, is in upscale Pacific Heights. It has just broken ground on a $2.7 billion renovation, which includes a new flagship hospital. Though the project was initiated to meet new state earthquake standards, the facility is designed as a sleek glass and marble structure with all private rooms, underground parking and roof gardens with flowers and bees "to enhance the quality of the healing environment," according to California Pacific Medical Center's website. Its Facebook page has called it "the coolest hospital in San Francisco, possibly the country and even the world."
Consumers may appreciate — or demand — features that contribute to bigger hospital bills. But studies have found no correlation between prices and patient outcomes. A California state rating of hospital services by the California Health Care Foundation gave California Pacific Medical Center average scores in most categories, though its surgical-care measures were rated "superior."
Its crosstown neighbor, University of California San Francisco, a nationally ranked academic institution, charges far less per day than California Pacific, when the greater severity of illnesses of its patients is factored in, Professor Melnick said. In fact, a recent study in the publication Annals of Surgery, a monthly review of surgical science, found that hospitals with the highest complication rates tended to have higher prices.
From such variations, economists conclude that "costs" are highly discretionary, noting that hospitals in other developed countries often provide high-quality care, with better outcomes in comparatively no-frills environments. Said Dr. Robinson, the Berkeley health economist: "If you pay hospitals more, they spend it. If you pay them less, they adjust. The only way to pay less for health care — is to pay less for health care."
Hospital officials like to say that their list prices do not reflect what most patients actually pay, because private and government insurers negotiate discounts. Simone Singh, a professor of health management and policy at the University of Michigan, estimated that insurers generally paid 40 to 50 percent of charges. But with powerful chains like Sutter, prices are high and the discounts often are not so generous. Patients are left paying more.
A Price 'Sequoia'
For her three stitches at California Pacific Medical Center, Deepika Singh ended up paying $768.56 — a lot of money for a 26-year-old retail supply chain manager — of the $1,813 rate her insurer negotiated for the approximately $2,200 bill. Ms. Duffy owed $1,366 after her insurer's discount on 2-year-old Orla's $1,700 bill, since the family had not met its annual deductible. "How much is that per minute?" she asked.
Across California, Sutter hospitals have proved expert at the business of medicine. "Our members are very exercised about Sutter — it has increased prices disproportionately," said David Lansky, chief executive officer of the Pacific Business Group on Health, which represents 60 of California's biggest private employers in its health care negotiations. "Sutter has been successful at leveraging their huge size in dictating not just price but contract terms."
Its major competitor is Kaiser, a health maintenance organization that runs a closed network of hospitals and doctors. California Pacific Medical Center delivers more than half the babies in San Francisco and is the city's largest employer after Wells Fargo. Sutter contracts also include "gag clauses" that prevent employers from knowing what rates have been negotiated by their insurers on their behalf, Mr. Lansky said.
Chuck Idelson, a spokesman for the Institute for Health and Socio-Economic Policy, the research arm of the California Nurses Association, said Sutter prices were 40 to 70 percent above its rivals' for similar services. When Sutter bought Summit Hospital in Oakland in 1999, rates there went up 29 percent to 72 percent, researchers found. Because of pricing issues, proposed insurance plans under the Affordable Care Act did not initially include Sutter hospitals.
Terry Miller, 62, a businessman in the Bay Area, got a bill for $117,000 for a two-night stay at California Pacific Medical Center to place a stent to open one of his heart's clogged arteries — a charge that did not include fees for the cardiologist and radiologist. According to the Medicare database, California Pacific Medical Center charged $43,679 for hospitalization to treat a simple pneumonia and $96,642 to treat a stroke; the Medicare payments for those illnesses were $8,046 and $9,583.
The high prices have had a ripple effect across Northern California, allowing smaller hospitals to charge more as well. "Sutter is the tallest Sequoia and everyone goes up just underneath them a bit," said Professor Melnick. He noted that hospital prices in California had more than doubled in the past decade, after adjustment for inflation.
And payouts in the Pacific region for simple emergency room treatments — stitches, a sprained ankle and an upper respiratory infection — were by far the highest in the country, about 50 percent higher than in the Northeast, according to an analysis performed for The Times. by the health care consulting firm Truven Health Analytics.
The Merger Factor
In theory, health care consolidation can lead to economies of scale, but not if it produces complex supersize systems. Excess administrative costs accounted for about $190 billion of the $2.5 trillion medical bill of the United States in 2009, the Institute of Medicine estimated this year — money that could be used for other purposes.
"There is a big flurry of consolidation and the effects depend on what the objective of the health care system is," said Orry Jacobs of the health care consulting firm BDC Advisors. "If the intent is to improve care and bend cost curves, then networks can do so. If the objective is to corner the market and demand higher rates, then that will happen." Indeed, research shows that today's hospital mergers tend to drive up prices.
And employers have limited ability to fight back. Sutter operates the only hospital in some California cities. Beginning on Jan. 1, the University of California, Berkeley, will exclude Sutter's two nearby hospitals from its plan because it could not reach a price agreement. The university's employees will have to cross the bay or drive inland for in-network hospital treatment, or pay more.
As is often the case in American medicine, patients will decide if they are willing to pay the high price of care. Back home in New York City, Orla Duffy's head wound has healed nicely without further treatment. Deepika Singh had her stitches taken out at an urgent care clinic, costing $25 with her copay, during a business trip to Washington.
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."
You get what you pay for. In this case American inefficiency.
Inefficiency, hell. There's nothing inefficient about profits.
We really need an NHS. It's too late for anything else; Just nationalize everything.
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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.
The Canadian model doesn't provide enough profits in forcing people into bankruptcy for getting into debilitating car accidents or developing cancer, so that means it's Communism. Just wouldn't work here.
Can someone get Seeds some sort of job so he can tamper down his whining?
Says the collaborator.
For my recent trip first to a medical centre and then to the hospital to have 4/5 stitches put in my chin, could well have cost me $2,000-3,000 in America. :hmm:
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
Please not I'm not saying this is likely to happen, but that it's a fear one doesn't need whilst travelling.
C'mon, Mongers, live dangerously. Living in America is like going to Vegas, only you put up everything every time you leave the house.
That little old lady that doesn't see you at the stop sign could cost you your home. You just can't beat that kind of excitement!
This is the logic of our pseudo-"private" system of health care delivery. The ultimate consumer has zero negotiating power and is a pure price taker; the provider can price however it likes with no effective market discipline. Result - market failure because there is no real market to speak of. The only player with sufficient power to bargain with oligolopoly providers are the oliogopoly insurers. The discounted prices they negotiate are closer approximations to market outcomes, although they are still entirely opaque and the insurer's incentive to push for cost reductions may be vitiated by its ability to pass costs on to the consumer.
There is an interesting intersection between this problem and the storm of protest about people not keeping "their plan" under Obamacare. The plans that tend to be subject to cancellation are high deductible catastrophic only plans. But these are precisely the kind of people that are subject to getting gouged by hospital over-pricing because their cheap insurance doesn't cover more routine care or only does so with very steep deductibles - indeed several such people are quoted in this article. That is why OBAMABENGHAZILIAR and Ideologue's griping aside, Obamacare makes a certain amount of sense (albeit paternalistically) - it pushes consumers out of the health care craps game where the House is totally stacked against them and they pay Saudi tycoon prices, and creates some modicum amount of pressure for competition among insurers. And it also is part of the reason that Obamacare critics tend to fail because the lack of alternatives that address the huge problems with the current system
Quote from: CountDeMoney on December 03, 2013, 02:10:54 PM
C'mon, Mongers, live dangerously. Living in America is like going to Vegas, only you put up everything every time you leave the house.
That little old lady that doesn't see you at the stop sign could cost you your home. You just can't beat that kind of excitement!
:D
Conversely you could consider moving somewhere, where the cost of seeking medical treatment doesn't cross ones mind. Quite pleasant. :bowler:
QuoteAs 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.
Quote from: Fate on December 03, 2013, 02:58:31 PM
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.
Quote from: Syt on December 03, 2013, 03:02:01 PM
Quote from: Fate on December 03, 2013, 02:58:31 PM
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.
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.
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...
Quote from: KRonn on December 03, 2013, 03:06:17 PM
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.
Quote from: Fate on December 03, 2013, 02:58:31 PM
QuoteAs 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?
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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?
Quote from: Iormlund on December 03, 2013, 04:50:45 PM
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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.
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.
Quote from: Barrister on December 03, 2013, 05:04:08 PM
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.
Quote from: The Minsky Moment on December 03, 2013, 05:48:48 PM
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.
Quote from: Admiral Yi on December 03, 2013, 05:54:58 PM
Quote from: The Minsky Moment on December 03, 2013, 05:48:48 PM
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. :lol:
Quote from: Admiral Yi on December 03, 2013, 05:54:58 PM
Quote from: The Minsky Moment on December 03, 2013, 05:48:48 PM
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).
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.
Quote from: 11B4V on December 03, 2013, 05:58:34 PM
Quote from: Admiral Yi on December 03, 2013, 05:54:58 PM
Quote from: The Minsky Moment on December 03, 2013, 05:48:48 PM
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. :lol:
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.
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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?
Quote from: Tyr on December 03, 2013, 08:08:34 PM
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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?
As far as I know in those cases the single payer, having all negotiating power, either fixes the prices for each procedure/treatment or pays a fixed yearly amount for each potential "customer".
Problem is both avenues are liable to create perverse incentives. The first as BB mentioned tends to make healthcare more expensive as unneeded measures are undertaken. The second means care suffers as only the bare minimum is given.
On a related note, the FBI estimates the federal government is being bilked out of $70 to $240 billion a year in health care related frauds.
Quote from: Admiral Yi on December 03, 2013, 09:41:45 PM
On a related note, the FBI estimates the federal government is being bilked out of $70 to $240 billion a year in health care related frauds.
Yeah, lots of fraud, huge numbers, not small stuff. I think I've seen estimates of over 100 billion fraud in Medicare. Lots of doctors and clinics get nailed in fraud cases. Kind of alarming that the govt can't seem to clean things up so well. That kind of money would go a long way to needed causes in health care.
That's nuts.
You should outsource your healthcare policy to us. We'll get half what you save. Crisis over.
I agree that's nuts. That's a lot of fucking coin.
That would have regulatory stuff involved. Bad move.
Quote from: Tyr on December 03, 2013, 08:08:34 PM
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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?
Well when the government is the only client for at least 99% of your work they can pretty much set their price.
Quote from: Admiral Yi on December 03, 2013, 09:41:45 PM
On a related note, the FBI estimates the federal government is being bilked out of $70 to $240 billion a year in health care related frauds.
70 bucks isn't so bad, but the 240 billion could be fairly hefty.
:face:
;)
FBI website says the cost to the "country" is 80 billion. That includes public and private. No explanation of how number is derived.
Quote from: mongers on December 03, 2013, 02:03:41 PM
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
So what you are saying is that American health insurance is costly enough to keep out the bums? Maybe it is worth the price, then.
Quote from: 11B4V on December 03, 2013, 05:58:34 PM
Quote from: Admiral Yi on December 03, 2013, 05:54:58 PM
Quote from: The Minsky Moment on December 03, 2013, 05:48:48 PM
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. :lol:
Exactly. Why kill off the goose that lays the golden egg? If you convince the NOK to keep the vegetable alive, you can have many more counselling sessions; allow them to do the decent thing, and the stream of counselling sessions dries up.
Quote from: grumbler on December 04, 2013, 07:10:29 AM
Quote from: mongers on December 03, 2013, 02:03:41 PM
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
So what you are saying is that American health insurance is costly enough to keep out the bums? Maybe it is worth the price, then.
Nowadays you're really not trying hard enough to entertain me.
One thread of yours I fondly remember, was the one about the woman who was having problems with her husband or whatever, and you were providing a shoulder to cry on/hoping to see here; man did I laugh my ass off, at your pathetic display over that.
Quote from: mongers on December 04, 2013, 07:34:09 AM
Nowadays you're really not trying hard enough to entertain me.
Maybe the purpose of people in the world isn't just to entertain you? :hmm:
QuoteOne thread of yours I fondly remember, was the one about the woman who was having problems with her husband or whatever, and you were providing a shoulder to cry on/hoping to see here; man did I laugh my ass off, at your pathetic display over that.
It is kind of sad to see what delusions you come up with when you are off your meds. The only one you embarrass with these kinds of stories about supposedly "pathetic" behavior of others in some vague thread (that is lost to time anyway) is you.
Mongers just wistfully pines for a time when there was a kindler, gentler grumbler.
Unfortunately, we've invented the light bulb since then. :lol:
Quote from: grumbler on December 04, 2013, 09:13:44 AM
Quote from: mongers on December 04, 2013, 07:34:09 AM
Nowadays you're really not trying hard enough to entertain me.
Maybe the purpose of people in the world isn't just to entertain you? :hmm:
QuoteOne thread of yours I fondly remember, was the one about the woman who was having problems with her husband or whatever, and you were providing a shoulder to cry on/hoping to see here; man did I laugh my ass off, at your pathetic display over that.
It is kind of sad to see what delusions you come up with when you are off your meds. The only one you embarrass with these kinds of stories about supposedly "pathetic" behavior of others in some vague thread (that is lost to time anyway) is you.
I was being charitable, assuming you were trying to amuse, rather than you just being a cunt.
I think I'm happy to leave it up to the court of opinion on Languish as to whom is acting pathetically on the forum; me just posting an opinion/feeling in a normal thread or you're quasi-stalking behaviour following posters around from thread to thread taking pot-shots at them.
Quote from: CountDeMoney on December 04, 2013, 09:19:49 AM
Mongers just wistfully pines for a time when there was a kindler, gentler grumbler.
Look at the comment he got his panties in a twist over. It was about as innocuous a twig as one could find on the internet.
I mean, really; posting a long, rambling attempt at an insult that involves making shit up and invoking dead threads just because someone implied you might be a bum? That's evidence of a knickertwist that has cut off the oxygen supply to the brain.
Quote from: mongers on December 04, 2013, 09:20:45 AM
I was being charitable, assuming you were trying to amuse, rather than you just being a cunt.
See what I mean, Seedy? I merely imply in a humorous way that he is a bum, and he outright calls me a "cunt" for it. No over-reaction here! :lol:
QuoteI think I'm happy to leave it up to the court of opinion on Languish as to whom is acting pathetically on the forum; me just posting an opinion/feeling in a normal thread or you're quasi-stalking behaviour following posters around from thread to thread taking pot-shots at them.
Oh, I think it is clear to everyone who it is that is doing the stalking and the pathetic over-reactions! :lol:
Quote from: grumbler on December 04, 2013, 09:24:30 AM
Quote from: CountDeMoney on December 04, 2013, 09:19:49 AM
Mongers just wistfully pines for a time when there was a kindler, gentler grumbler.
Look at the comment he got his panties in a twist over. It was about as innocuous a twig as one could find on the internet.
I mean, really; posting a long, rambling attempt at an insult that involves making shit up and invoking dead threads just because someone implied you might be a bum? That's evidence of a knickertwist that has cut off the oxygen supply to the brain.
Let's just see whose supply of oxygen to the brain gives out first; I feel for you, tirelessly giving up you're last few years on earth to post snide comments on internet fora.
You'll be missed. :(
Quote from: mongers on December 04, 2013, 09:20:45 AM
you're quasi-stalking behaviour following posters around from thread to thread taking pot-shots at them.
Awesome! It has been a while since we got a good stalker accusation.
Quote from: mongers on December 04, 2013, 09:31:08 AM
Let's just see whose supply of oxygen to the brain gives out first; I feel for you, tirelessly giving up you're last few years on earth to post snide comments on internet fora.
You'll be missed. :(
I'm not going to respond to this, I just wanted to preserve it in all its inarticulate glory.
Quote from: CountDeMoney on December 04, 2013, 09:19:49 AM
Mongers just wistfully pines for a time when there was a kindler, gentler grumbler.
I remember the thread Mongers is talking about. :ph34r: Days long gone by... :sleep:
This should be resolved by duel. Mongers in his penny-farthing vs. grumbler in his scythed chariot.
Stalking accusations are ridiculous on a forum this small.
Quote from: Peter Wiggin on December 04, 2013, 12:44:39 PM
Stalking accusations are ridiculous on a forum this small.
Walk a mile in my shoes.
Quote from: Barrister on December 03, 2013, 05:04:08 PM
Quote from: Iormlund on December 03, 2013, 04:50:45 PM
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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.
That is simply false. The main problem with the American model is that it has no cost discipline. There are significant advantages to our system which do remove the kinds of perverse incentives built into the US system. For example the fact that provincial governments negotiate directly with drug companies to establish the price at which the provinces will pay for medications dramatically reduces the cost. Hospitals also obtain their medical supplies through the same kind of system which further reduces cost - (ie no one is paying 500 bucks per stitch). That kind of negotiating power would rarely if ever exist in the American model. Also, the fact that doctors are paid a set tariff fee, depending on their specialty and what they are billing for, controls costs.
QuoteThe 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 rates are reviewed regularly (at least here in BC) by the College of Physicians and Surgeons and the Province to ensure the rates reflect the time required for a given procedure. It would very unlikely a doctor could "pack as many patients in a day as possible" without extending the day....
Regarding your allegation that there are few disincentives to order "a whole battery of tests or procedures" you need to look at what incentive there is to do so. In the US the main driver of this problem is malpractice litigation. Because of that risk doctors err on the side of caution to protect themselves in case someone makes an allegation that xyz test ought to have been ordered. Here in Canada that ligitation risk exists but to a much lesser extent given how our malpractice law has developed. Also, in Canada the doctor has no profit motive for ordering additional tests. Doctors in the US may have such a motive (or at lest the hospitals they might work within).
Before you make these kinds of accusations you might want to look at what the College of Physicians and Surgeons is doing proactively to help educate doctors to ensure tests are limited to only those that are necessary. While it is true that all systems can be improved, your allegation that Canadian sytem creates an incentive for doctors to order whole batteries of tests and procedures that are unncessary is questionable at best.
QuoteThe 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.
I am not sure what not covering optional medical procedures has to do with the US death panels. I dont think tax payors should have to pay for some vain old person who wants a face lift.
Regarding your allegation that it is tough to de-list a procedure, if you do a quick google search you will see that the pressure is on the other side - the criticism generally is that procedures and drugs are being de-listed even though it is alleged they might be medically necessary.
Quote from: grumbler on December 04, 2013, 09:43:28 AM
Quote from: mongers on December 04, 2013, 09:31:08 AM
Let's just see whose supply of oxygen to the brain gives out first; I feel for you, tirelessly giving up you're last few years on earth to post snide comments on internet fora.
You'll be missed. :(
I'm not going to respond to this, I just wanted to preserve it in all its inarticulate glory.
But you did. Classic Grumbler attacking a post because it has a couple of typos, rather than the substance of the post; OMG I typed whose instead of who's and you're in place of your. :gasp:
Quote from: The Minsky Moment on December 04, 2013, 12:08:51 PM
This should be resolved by duel. Mongers in his penny-farthing vs. grumbler in his scythed chariot.
JR, that's grossly unfair.
There's no way I'm attacking someone infirm of mind or spirit.
Quote from: crazy canuck on December 04, 2013, 01:22:50 PM
Quote from: Barrister on December 03, 2013, 05:04:08 PM
Quote from: Iormlund on December 03, 2013, 04:50:45 PM
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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.
That is simply false. (snip)
I think that you are correct to note that a failure to completely eliminate perverse incentives is not the same as dealing poorly with them. The same rules and procedures that yield a positive outcome in 90% of cases can still lead to perverse outcomes in some or all of the remaining 10%, and still be acceptable.
I believe that perverse incentives is a problem to be controlled as far as possible but that it is a problem that, like the problem of false positives, cannot be eliminated without eliminating the good in the system as well.
I don't have a forum stalker except katmai. :(
Quote from: The Brain on December 04, 2013, 01:46:06 PM
I don't have a forum stalker except katmai. :(
You can have mongers. He will deny stalking me, anyway (even if he admitted it in this thread), so you can claim him without fear of contradiction.
Quote from: mongers on December 03, 2013, 02:03:41 PM
For my recent trip first to a medical centre and then to the hospital to have 4/5 stitches put in my chin, could well have cost me $2,000-3,000 in America. :hmm:
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
Please not I'm not saying this is likely to happen, but that it's a fear one doesn't need whilst travelling.
They wouldn't comprimise treatment, and ultimately, they can't make you pay. No one is going to fly across the ocean to break your knees.
Quote from: alfred russel on December 04, 2013, 02:23:43 PM
Quote from: mongers on December 03, 2013, 02:03:41 PM
For my recent trip first to a medical centre and then to the hospital to have 4/5 stitches put in my chin, could well have cost me $2,000-3,000 in America. :hmm:
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
Please not I'm not saying this is likely to happen, but that it's a fear one doesn't need whilst travelling.
They wouldn't comprimise treatment, and ultimately, they can't make you pay. No one is going to fly across the ocean to break your knees.
They will however put you on a plane to Syria if you ever enter the US again.
The purchasing power of a neurosurgeon at a Maserati dealership is not a perverse incentive, g.
Quote from: The Brain on December 04, 2013, 01:46:06 PM
I don't have a forum stalker except katmai. :(
Don't be so sure he's restricting it to forum only. I heard (secondhand) that he'd been checking prices on tickets to Stockholm. :ph34r:
Quote from: Peter Wiggin on December 04, 2013, 02:37:26 PM
Quote from: The Brain on December 04, 2013, 01:46:06 PM
I don't have a forum stalker except katmai. :(
Don't be so sure he's restricting it to forum only. I heard (secondhand) that he'd been checking prices on tickets to Stockholm. :ph34r:
I don't worry. I was just told no one would do that.
Quote from: grumbler on December 04, 2013, 01:56:33 PM
Quote from: The Brain on December 04, 2013, 01:46:06 PM
I don't have a forum stalker except katmai. :(
You can have mongers. He will deny stalking me, anyway (even if he admitted it in this thread), so you can claim him without fear of contradiction.
Do demonstrate that.
The problem with having 'a grumbler' is perhaps similar to treading in dog shit, you think you've gotten the last off the shoe, but the smell lingers.
Do keep posting snide replies to my posts, as I figure it takes up time, which you might otherwise utilise to take pot-shot at some of our more vulnerable members on the forum.
Quote from: alfred russel on December 04, 2013, 02:23:43 PM
Quote from: mongers on December 03, 2013, 02:03:41 PM
For my recent trip first to a medical centre and then to the hospital to have 4/5 stitches put in my chin, could well have cost me $2,000-3,000 in America. :hmm:
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
Please not I'm not saying this is likely to happen, but that it's a fear one doesn't need whilst travelling.
They wouldn't comprimise treatment, and ultimately, they can't make you pay. No one is going to fly across the ocean to break your knees.
Oh, I don't doubt the wisdom and the experience of what you're saying, it just one of those niggles at the back of one's mind, when you should be trouble free whilst holidaying.
Which is why the pan-European system of reciprocal health cover is somewhat re-assuring.
Quote from: The Brain on December 04, 2013, 02:42:29 PM
I don't worry. I was just told no one would do that.
Willingly travel to Sweden? :hmm: You're probably right.
Quote from: Admiral Yi on December 04, 2013, 01:00:57 PM
Quote from: Peter Wiggin on December 04, 2013, 12:44:39 PM
Stalking accusations are ridiculous on a forum this small.
Walk a mile in my shoes.
I've walked several miles in close proximity to your shoes.
:P
Well, now I feel the need to clarify. Responding to posts in many/most threads you post in is not stalking. Trying to track down somebody's home address is.
Quote from: alfred russel on December 04, 2013, 02:23:43 PM
Quote from: mongers on December 03, 2013, 02:03:41 PM
For my recent trip first to a medical centre and then to the hospital to have 4/5 stitches put in my chin, could well have cost me $2,000-3,000 in America. :hmm:
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
Please not I'm not saying this is likely to happen, but that it's a fear one doesn't need whilst travelling.
They wouldn't comprimise treatment, and ultimately, they can't make you pay. No one is going to fly across the ocean to break your knees.
dude really? Clean it out real well and use some Steri-strips aka Butterfly stitches.
For Christ's sake.
Quote from: Peter Wiggin on December 04, 2013, 04:21:08 PM
Well, now I feel the need to clarify. Responding to posts in many/most threads you post in is not stalking. Trying to track down somebody's home address is.
You already jumped the shark with your ridiculous Krackel comment. Cut your losses dude.
Quote from: Peter Wiggin on December 04, 2013, 12:44:39 PM
Stalking accusations are ridiculous on a forum this small.
amazed that no one said this yet: "oh no, Languish is dieing!"
I stand by my Krackel comment 100%.
Quote from: 11B4V on December 04, 2013, 04:25:23 PM
Quote from: alfred russel on December 04, 2013, 02:23:43 PM
Quote from: mongers on December 03, 2013, 02:03:41 PM
For my recent trip first to a medical centre and then to the hospital to have 4/5 stitches put in my chin, could well have cost me $2,000-3,000 in America. :hmm:
This is the reason I wouldn't visit America, have an accident and despite medical travel insurance, risk ending up in some administrative BS that leave you with a big bill or possible compromised treatment because of uncertainty of who's paying. :(
Please not I'm not saying this is likely to happen, but that it's a fear one doesn't need whilst travelling.
They wouldn't comprimise treatment, and ultimately, they can't make you pay. No one is going to fly across the ocean to break your knees.
dude really? Clean it out real well and use some Steri-strips aka Butterfly stitches.
For Christ's sake.
Oh I know, but the other person insisted on taking me to the medical centre, then the nurses/women all act like mother hens, so I ended up having to have a hospital procedure.
And the doctor there did such a good stitching job, doesn't look like I'll have any decent/manly scar at all on my chin. :(
Quote from: Peter Wiggin on December 04, 2013, 03:11:31 PM
Quote from: The Brain on December 04, 2013, 02:42:29 PM
I don't worry. I was just told no one would do that.
Willingly travel to Sweden? :hmm: You're probably right.
Stockholm is a wonderful city.
Quote from: 11B4V on December 04, 2013, 04:25:23 PM
dude really? Clean it out real well and use some Steri-strips aka Butterfly stitches.
For Christ's sake.
That's just it - the people I know in the US who are concerned about their insurance situation would rather perform relatively simple medical procedures on themselves than risk the bills. Also, they generally won't go to the doctor if they
think something might be wrong - they wait until they are
sure.
Both strike me as fundamentally bad ideas, likely to lead to more costs in the future rather than less (to say nothing of worse outcomes). Preventing stuff is cheaper than fixing stuff.
Quote from: Malthus on December 05, 2013, 08:11:36 AM
Quote from: 11B4V on December 04, 2013, 04:25:23 PM
dude really? Clean it out real well and use some Steri-strips aka Butterfly stitches.
For Christ's sake.
That's just it - the people I know in the US who are concerned about their insurance situation would rather perform relatively simple medical procedures on themselves than risk the bills. Also, they generally won't go to the doctor if they think something might be wrong - they wait until they are sure.
Both strike me as fundamentally bad ideas, likely to lead to more costs in the future rather than less (to say nothing of worse outcomes). Preventing stuff is cheaper than fixing stuff.
Unsure of what your trying to equate here. By your last sentence, your stating Mongers should watch where his walking and that would have prevented the injury.
Quote from: 11B4V on December 05, 2013, 10:58:57 AM
Quote from: Malthus on December 05, 2013, 08:11:36 AM
Quote from: 11B4V on December 04, 2013, 04:25:23 PM
dude really? Clean it out real well and use some Steri-strips aka Butterfly stitches.
For Christ's sake.
That's just it - the people I know in the US who are concerned about their insurance situation would rather perform relatively simple medical procedures on themselves than risk the bills. Also, they generally won't go to the doctor if they think something might be wrong - they wait until they are sure.
Both strike me as fundamentally bad ideas, likely to lead to more costs in the future rather than less (to say nothing of worse outcomes). Preventing stuff is cheaper than fixing stuff.
Unsure of what your trying to equate here.
I am pretty sure he is equating a medical system which creates incentives for people to treat themselves for medical issues that might in the end be more costly if they do it wrong as being short sighted, inefficient and idiotic.
Quote from: Admiral Yi on December 04, 2013, 01:00:57 PM
Quote from: Peter Wiggin on December 04, 2013, 12:44:39 PM
Stalking accusations are ridiculous on a forum this small.
Walk a mile in my shoes.
Wouldn't that be stalking? Or will you take them off first?
Quote from: Crazy_Ivan80 on December 04, 2013, 04:27:27 PM
Quote from: Peter Wiggin on December 04, 2013, 12:44:39 PM
Stalking accusations are ridiculous on a forum this small.
amazed that no one said this yet: "oh no, Languish is dieing!"
It's an American hosted forum. We can't afford to die. The medical costs would be too high.
Having just had a baby in Canada, I can say that I'm pretty happy with that part of the medical system.
The hospital we went to - BC Women's Hospital - has a policy of one nurse per patient during labour, and one nurse for every four post-partum. We had a nice private room with all kinds of ameneties, and we stayed for a few extra days for observation. Our out of pocket costs: $0.
BB may be right that there are perverse incentives somewhere in our system, but whatever they are I'm fine with them if the alternative is to worry about the potential financial impact of the hospital costs when having a baby - or when having any other kind of medical problem.
Another thing that I only recently learned about is a phone number you can call - 24 hours a day - to speak with a registered nurse practitioner about any kind of health issue. There's pretty much no wait time, and it's a really good way to prevent people from wasting clinic time with trivialities. It might just be a local thing for BC, or even Vancouver, though.
Quote from: Jacob on December 05, 2013, 01:41:38 PM
Having just had a baby in Canada, I can say that I'm pretty happy with that part of the medical system.
The hospital we went to - BC Women's Hospital - has a policy of one nurse per patient during labour, and one nurse for every four post-partum. We had a nice private room with all kinds of ameneties, and we stayed for a few extra days for observation. Our out of pocket costs: $0.
BB may be right that there are perverse incentives somewhere in our system, but whatever they are I'm fine with them if the alternative is to worry about the potential financial impact of the hospital costs when having a baby - or when having any other kind of medical problem.
Another thing that I only recently learned about is a phone number you can call - 24 hours a day - to speak with a registered nurse practitioner about any kind of health issue. There's pretty much no wait time, and it's a really good way to prevent people from wasting clinic time with trivialities. It might just be a local thing for BC, or even Vancouver, though.
Hey congratulations to all three of you. :cheers:
How come I missed this news, didn't you have a thread for the new arrival ? :unsure:
Quote from: Jacob on December 05, 2013, 01:41:38 PM
Another thing that I only recently learned about is a phone number you can call - 24 hours a day - to speak with a registered nurse practitioner about any kind of health issue. There's pretty much no wait time, and it's a really good way to prevent people from wasting clinic time with trivialities. It might just be a local thing for BC, or even Vancouver, though.
My health care plan has that same feature. It is so common-sensical that you'd think that any system without it is being moronic, but even with my provider it is only two years or so old.
Quote from: mongers on December 05, 2013, 01:44:31 PMHey congratulations to all three of you. :cheers:
Thanks :)
QuoteHow come I missed this news, didn't you have a thread for the new arrival ? :unsure:
Don't think I had a thread, but I did mention it at some point.
Quote from: grumbler on December 05, 2013, 01:46:39 PMMy health care plan has that same feature. It is so common-sensical that you'd think that any system without it is being moronic, but even with my provider it is only two years or so old.
Yeah, it makes a lot of sense.
I'm just enough of a socialist that I think everyone should have access to that kind of service :)
Quote from: Malthus on December 05, 2013, 08:11:36 AM
Both strike me as fundamentally bad ideas, likely to lead to more costs in the future rather than less (to say nothing of worse outcomes). Preventing stuff is cheaper than fixing stuff.
I've seen studies on this topic...it certainly sounds good...regular health screenings and tests not only promote good health but also save money. Unfortunately the saving money part doesn't seem to be accurate.
Quote from: Jacob on December 05, 2013, 01:47:19 PM
Quote from: mongers on December 05, 2013, 01:44:31 PMHey congratulations to all three of you. :cheers:
Thanks :)
QuoteHow come I missed this news, didn't you have a thread for the new arrival ? :unsure:
Don't think I had a thread, but I did mention it at some point.
Well you need one anyway, to post child development/amusing incidents/just how dog tired both of you are getting. :D
Quote from: Jacob on December 05, 2013, 01:41:38 PM
Having just had a baby in Canada, I can say that I'm pretty happy with that part of the medical system.
The hospital we went to - BC Women's Hospital - has a policy of one nurse per patient during labour, and one nurse for every four post-partum. We had a nice private room with all kinds of ameneties, and we stayed for a few extra days for observation. Our out of pocket costs: $0.
BB may be right that there are perverse incentives somewhere in our system, but whatever they are I'm fine with them if the alternative is to worry about the potential financial impact of the hospital costs when having a baby - or when having any other kind of medical problem.
Another thing that I only recently learned about is a phone number you can call - 24 hours a day - to speak with a registered nurse practitioner about any kind of health issue. There's pretty much no wait time, and it's a really good way to prevent people from wasting clinic time with trivialities. It might just be a local thing for BC, or even Vancouver, though.
Just for a comparison: when our newest baby was born, during labour the nurse was shared. I had to go find someone to say "look - my wife is ready to have this baby NOW". Private room for delivery, but not for afterwards (despite me having a health plan that would cover a private room). Kicked out within 12 hours after having the baby (though honestly with the shared room we wanted out anyways).
Alberta has a toll free number as well. When I've called it though they are really less than helpful, and are doing more to cover their own butts from malpractice than to give meaningful advice.
For what its worth though having a baby in Whitehorse was completely different experience.
Well, healthcare is a provincial concern for the last while and Alberta does seem to tend less towards public services, so I guess it's not surprising.
It does sound pretty sucky :console:
Alberta sucks. News at 11
Quote from: alfred russel on December 05, 2013, 01:48:33 PM
I've seen studies on this topic...it certainly sounds good...regular health screenings and tests not only promote good health but also save money. Unfortunately the saving money part doesn't seem to be accurate.
Of course not. Poor people who live longer need more services.
The Russians have found away to pay for their medical expenses in the US, Mongers. You can too!
QuoteRussian diplomats accused of $1.5M Medicaid fraud
NEW YORK (AP) - Dozens of current or former Russian diplomats and their spouses enjoyed luxury vacations and spent tens of thousands of dollars on concert tickets, fine clothing and helicopter rides as they lied about their incomes to get the U.S. government to pay their health care bills with money meant for the poor, federal prosecutors said Thursday.
The diplomats were among 49 individuals charged in a complaint unsealed in federal court in Manhattan, though no arrests were made and only 11 of the diplomats and their spouses remained in the United States. The complaint said Medicaid, a health care program for the poor, lost about $1.5 million in the scheme since 2004.
"Diplomacy should be about extending hands, not picking pockets in the host country," U.S. Attorney Preet Bharara told a Manhattan news conference. He called it "shameful and systemic corruption."
Russia's Deputy Foreign Minister Sergei Ryabkov said in remarks carried by the Interfax news agency that "we are bewildered by making the information about accusations of alleged tax and other offenses by Russian embassy personnel available to the media."
"It's not clear why the relevant agencies have considered it possible to make these accusations public before discussing them through diplomatic channels," he said.
"We can't make any comment on that until we receive a clear explanation of the charges against our citizens from the U.S. authorities," Ryabkov added.
Russian officials at the United Nations did not immediately comment.
The defendants include employees of Russia's consulate and its mission to the U.N., as well as trade representative, according to the criminal complaint.
The complaint alleges that the defendants submitted fraudulent applications for medical benefits for pregnancies, births and care for young children. Federal prosecutors said the diplomats qualified for Medicaid benefits by underreporting their income, often by tens of thousands of dollars.
Bharara said it was a case "we would be prosecuting and making arrests in, but for immunity." Still, he added, participation in crimes by diplomats generally leads to expulsion from a country.
"Being a diplomat does not give you the right to commit health care fraud," said George Venizelos, head of the FBI's New York office. He said 25 current and former diplomats and 24 of their spouses joined with dozens of co-conspirators not identified in court papers to carry out the fraud.
"The defendants selfishly took advantage of a health care system designed to help the unfortunate," Venizelos said.
In court papers, FBI agent Jeremy Robertson described an 18-month investigation, saying investigators had discovered a pattern of falsified applications.
He said 58 of the 63 births attributed to Russian diplomats and their spouses in New York City between 2004 and 2013 were funded through Medicaid, which is largely federally funded but includes money from state and local governments.
Robertson wrote that the diplomats and their spouses generally underreported household income to an amount below the applicable Medicaid eligibility level, and some of them lied about the citizenship status of their children to obtain continuing health coverage for them.
Meanwhile, the diplomats and their spouses spent tens of thousands of dollars on vacations, fancy watches, expensive jewelry and designer clothing at luxury retail stores including Bloomingdale's, Tiffany & Co., Jimmy Choo, Swarovski and others, the court papers said.
The complaint said they also spent tens of thousands of dollars on electronic merchandise at Apple Inc. stores and elsewhere. Authorities said they also bought concert tickets, robotic cleaning devices and chartered helicopters.
Court papers noted that prior to June 2011 Russian diplomats including some of the defendants received their salaries in cash. The complaint said diplomats underreported their incomes to qualify for Medicaid but gave more accurate descriptions of salaries to qualify for credit cards.
Charges in the criminal complaint included conspiracy to commit health care fraud, conspiracy to steal government funds and make false statements relating to health care matters.
TRUST BUT VERIFY :angry:
I'm tired of Russia. And to think we sent them pop tarts when their economy collapsed.
What a waste.
Quote from: alfred russel on December 05, 2013, 01:48:33 PM
Quote from: Malthus on December 05, 2013, 08:11:36 AM
Both strike me as fundamentally bad ideas, likely to lead to more costs in the future rather than less (to say nothing of worse outcomes). Preventing stuff is cheaper than fixing stuff.
I've seen studies on this topic...it certainly sounds good...regular health screenings and tests not only promote good health but also save money. Unfortunately the saving money part doesn't seem to be accurate.
Screening creates more costs, because it leads to catching significant conditions when they are still treatable. Sad to tell, dying quickly of (say) cancer is a lot "cheaper" to the system than years of therapy.
Quote from: alfred russel on December 05, 2013, 01:48:33 PM
Quote from: Malthus on December 05, 2013, 08:11:36 AM
Both strike me as fundamentally bad ideas, likely to lead to more costs in the future rather than less (to say nothing of worse outcomes). Preventing stuff is cheaper than fixing stuff.
I've seen studies on this topic...it certainly sounds good...regular health screenings and tests not only promote good health but also save money. Unfortunately the saving money part doesn't seem to be accurate.
Regular screening is one thing. Avoiding going to the doctor once you know you have a problem because you can't afford it is another altogether.
Quote from: crazy canuck on December 05, 2013, 02:05:20 PM
Alberta sucks. News at 11
Impossible. I hear it is called the 'Texas of Canada'.
Quote from: Valmy on December 05, 2013, 11:03:00 PM
Quote from: crazy canuck on December 05, 2013, 02:05:20 PM
Alberta sucks. News at 11
Impossible. I hear it is called the 'Texas of Canada'.
I'm confused. You acted like you were disagreeing but then affirmed CC's statement. :hmm:
I'm still stunned that Jake just had a baby.
I guess all those Canadians and brits are not gonna come over anymore for service.
Quote from: Siege on December 06, 2013, 12:32:47 AM
I guess all those Canadians and brits are not gonna come over anymore for service.
I don't think cost was an issue for that crew.
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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.
*cough* provincial government *cough* unless it is like that outside Québec. ;)
Quote from: Rex Francorum on December 07, 2013, 01:39:31 AM
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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.
*cough* provincial government *cough* unless it is like that outside Québec. ;)
Without going into too much detail, the insurer is the provincial government, which receives funding (and guidelines) from the national government.
Quote from: Rex Francorum on December 07, 2013, 01:39:31 AM
*cough* provincial government *cough* unless it is like that outside Québec. ;)
It truly is the gathering of the Tribes of Israel. :cheers:
Quote from: Rex Francorum on December 07, 2013, 01:39:31 AM
Quote from: Barrister on December 03, 2013, 01:43:40 PM
Quote from: Grinning_Colossus on December 03, 2013, 01:28:26 PM
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.
*cough* provincial government *cough* unless it is like that outside Québec. ;)
*cough* equalization payments from the federal government transfering the wealth of the West (and NFLD) to fund the health care of the East including Quebec *cough*
Separatists like to ignore that little fact....
Well to be fair, it was his wife having the baby.
Quote from: katmai on December 07, 2013, 08:22:30 PM
Well to be fair, it was his wife having the baby.
Are you doubting the miracles of modern science? :angry:
Though his hips are a bit too slender to be good for birthing. -_-