Time is timely (http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/) with the discussion were having yesterday.
In '06, my morphine was over 7k. And I didn't use the trigger much.
Also, my wife looted my room. Towels, coffe mugs, boxes of unopened gloves.etc. They gonna charge me 250k+? WE ARE GONNA LOOT.
I'm in the wrong business and the wrong country. :(
Quote from: Malthus on February 22, 2013, 07:03:14 PM
I'm in the wrong business and the wrong country. :(
Stop moaning. You could have been a shopkeeper in Weimar Germany.
It's not. prescription medicine of any form is five or six quid here, though I've only ever had one adult prescription and that was some time ago.
Also how cheap are American pharmacy/over the counter products like say generic/ non-banded pain killers ?
edit:
I checked a prescription is now 7.65GBP say 11bucks.
If you're particularly sickly, you can one for $160 that covers whatever number and quantity of them your doctor/hospital perscribes over the course of a year.
Quote from: mongers on February 22, 2013, 07:09:11 PM
Also how cheap are American pharmacy/over the counter products like say generic/ non-banded pain killers ?
Depends on the product, but for painkillers :
http://www.amazon.com/Kirkland-Signature-Ibuprofen-Tablets-500-Tablets/dp/B002RL8FIO/ref=sr_1_1?ie=UTF8&qid=1361578399&sr=8-1&keywords=ibuprofen
~$.02 per pill.
Generics? 4.99 for a lot of places. Some have 'em for two bucks or free, like Amoxcillin at the meijer's chain.
Quote from: Ed Anger on February 22, 2013, 07:14:26 PM
Generics? 4.99 for a lot of places. Some have 'em for two bucks or free, like Amoxcillin at the meijer's chain.
So broadly similar, it's just the prescriptions that Americans get screwed on.
Quote from: Ed Anger on February 22, 2013, 06:54:46 PM
In '06, my morphine was over 7k. And I didn't use the trigger much.
Also, my wife looted my room. Towels, coffe mugs, boxes of unopened gloves.etc. They gonna charge me 250k+? WE ARE GONNA LOOT.
How very un 1% of you.
Quote from: mongers on February 22, 2013, 07:16:53 PM
Quote from: Ed Anger on February 22, 2013, 07:14:26 PM
Generics? 4.99 for a lot of places. Some have 'em for two bucks or free, like Amoxcillin at the meijer's chain.
So broadly similar, it's just the prescriptions that Americans get screwed on.
Those were prescriptions. Shoot, my Vicodin was dirt cheap.
Quote from: katmai on February 22, 2013, 07:17:01 PM
Quote from: Ed Anger on February 22, 2013, 06:54:46 PM
In '06, my morphine was over 7k. And I didn't use the trigger much.
Also, my wife looted my room. Towels, coffe mugs, boxes of unopened gloves.etc. They gonna charge me 250k+? WE ARE GONNA LOOT.
How very un 1% of you.
Let's not mention my looting of Materity.
Quote from: Ed Anger on February 22, 2013, 07:21:27 PM
Quote from: mongers on February 22, 2013, 07:16:53 PM
Quote from: Ed Anger on February 22, 2013, 07:14:26 PM
Generics? 4.99 for a lot of places. Some have 'em for two bucks or free, like Amoxcillin at the meijer's chain.
So broadly similar, it's just the prescriptions that Americans get screwed on.
Those were prescriptions. Shoot, my Vicodin was dirt cheap.
Oh so it's somewhat variable.
Over here iirc doctors do sometimes write prescriptions for things you can get much cheaper over the counter like iron pills or dressings, but I guess if get free prescription then every little helps.
Yeah, I was totally amazed at how cheap things were in Korea. It's one thing to know health care in America is expensive but another to go get an X-ray and be charged the equivalent of $6.36
Quote from: Malthus on February 22, 2013, 07:03:14 PM
I'm in the wrong business and the wrong country. :(
I thought you did work for pharma.
Quote from: Iormlund on February 22, 2013, 07:36:43 PM
Quote from: Malthus on February 22, 2013, 07:03:14 PM
I'm in the wrong business and the wrong country. :(
I thought you did work for pharma.
I do consulting legal work though, and in Canada. That's similar to being their accountant or something.
The big bucks are, clearly, in hospital management in the US.
A lot of the drug costs mentioned in the magazine story are hospital-administered. Charging a buck fifty for a tylenol or five grand for a single dose of a cancer drug.
Excerpts:
Quote
There is nothing, for example, that addresses what may be the most surprising sinkhole — the seemingly routine blood, urine and other laboratory tests for which Scott was charged $132,000, or more than $4,000 a day.
Quote
On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for "1 RITUXIMAB INJ 660 MG." That's an injection of 660 mg of a cancer wonder drug called Rituxan.
Quote
The expensive technology deployed on Janice S. was a bigger factor in her bill than the lab tests. An "NM MYO REST/SPEC EJCT MOT MUL" was billed at $7,997.54. That's a stress test using a radioactive dye that is tracked by an X-ray computed tomography, or CT, scan. Medicare would have paid Stamford $554 for that test.
Quote
In fact, Gilbert got three CT scans — of her head, her chest and her face. The last one showed a hairline fracture of her nose. The CT bills alone were $6,538. (Medicare would have paid about $825 for all three.) A doctor charged $261 to read the scans.
Gilbert got the same troponin blood test that Janice S. got — the one Medicare pays $13.94 for and for which Janice S. was billed $199.50 at Stamford. Gilbert got just one. Bridgeport Hospital charged 20% more than its downstate neighbor: $239.
Also on the bill were items that neither Medicare nor any insurance company would pay anything at all for: basic instruments and bandages and even the tubing for an IV setup. Under Medicare regulations and the terms of most insurance contracts, these are supposed to be part of the hospital's facility charge, which in this case was $908 for the emergency room.
Gilbert's total bill was $9,418.
Quote
The big-ticket item for Steve H.'s day at Mercy was the Medtronic stimulator, and that's where most of Mercy's profit was collected during his brief visit. The bill for that was $49,237.
According to the chief financial officer of another hospital, the wholesale list price of the Medtronic stimulator is "about $19,000."
Quote
The family's first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece. There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton's facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work.
Quote
Her insurance policy, from a company called Assurant Health, had an annual payout limit of $100,000. Because of some prior claims Assurant had processed, the S.'s were well on their way to exceeding the limit. Just the room-and-board charge at Southwestern was $2,293 a day. And that was before all the real charges were added. When Scott checked out, his 161-page bill was $474,064. Scott and Rebecca were told they owed $402,955 after the payment from their insurance policy was deducted. The top billing categories were $73,376 for Scott's room; $94,799 for "RESP SERVICES," which mostly meant supplying Scott with oxygen and testing his breathing and included multiple charges per day of $134 for supervising oxygen inhalation, for which Medicare would have paid $17.94; and $108,663 for "SPECIAL DRUGS," which included mostly not-so-special drugs such as "SODIUM CHLORIDE .9%." That's a standard saline solution probably used intravenously in this case to maintain Scott's water and salt levels. (It is also used to wet contact lenses.) You can buy a liter of the hospital version (bagged for intravenous use) online for $5.16. Scott was charged $84 to $134 for dozens of these saline solutions.
Then there was the $132,303 charge for "LABORATORY," which included hundreds of blood and urine tests ranging from $30 to $333 each, for which Medicare either pays nothing because it is part of the room fee or pays $7 to $30.
Quote
In fact, Palmer — echoing a constant and convincing refrain I heard from billing advocates across the country — alleged that the hospital triple-billed for some items used in Scott's care in the intensive-care unit. "First they charge more than $2,000 a day for the ICU, because it's an ICU and it has all this special equipment and personnel," she says. "Then they charge $1,000 for some kit used in the ICU to give someone a transfusion or oxygen ... And then they charge $50 or $100 for each tool or bandage or whatever that there is in the kit. That's triple billing."
Quote
Handcuffs On Medicare
Our laws do more than prevent the government from restraining prices for drugs the way other countries do. Federal law also restricts the biggest single buyer — Medicare — from even trying to negotiate drug prices. As a perpetual gift to the pharmaceutical companies (and an acceptance of their argument that completely unrestrained prices and profit are necessary to fund the risk taking of research and development), Congress has continually prohibited the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services from negotiating prices with drugmakers. Instead, Medicare simply has to determine that average sales price and add 6% to it.
The one huge advantage Medicare would have otherwise had...
Quote
"We use the CT scan because it's a great defense," says the CEO of another hospital not far from Stamford. "For example, if anyone has fallen or done anything around their head — hell, if they even say the word head — we do it to be safe. We can't be sued for doing too much."
The question is: What do we do about it?
This should not come as any surprise - this is entirely predictable given the basic setup that exists in the system. Barring changing the fundamentals of the system, what can be done to manage this?
Quote from: Berkut on February 22, 2013, 08:59:17 PM
The question is: What do we do about it?
This should not come as any surprise - this is entirely predictable given the basic setup that exists in the system. Barring changing the fundamentals of the system, what can be done to manage this?
I was just going to say that everyone knows
why it's expensive. What we don't know is what to do about it. It's not like we can barter lower prices like insurance companies or the feds. Basically, either you pay what they ask, or you suffer/die. We have zero options, and zero way to force them to charge less.
Quote from: merithyn on February 22, 2013, 09:20:20 PM
Quote from: Berkut on February 22, 2013, 08:59:17 PM
The question is: What do we do about it?
This should not come as any surprise - this is entirely predictable given the basic setup that exists in the system. Barring changing the fundamentals of the system, what can be done to manage this?
I was just going to say that everyone knows why it's expensive. What we don't know is what to do about it. It's not like we can barter lower prices like insurance companies or the feds. Basically, either you pay what they ask, or you suffer/die. We have zero options, and zero way to force them to charge less.
Revolution, insurrection, emigration ?
Hell put a few hospital administrators, CEOs and Insurance company CFOs up againt the wall and see prices tumble. :pitchfork:
One things for certain a political establishment awash with medical lobby money won't do anything, substantial to change these rotten boroughs.
Quote from: mongers on February 22, 2013, 09:29:40 PM
Revolution, insurrection, emigration ?
:mad:
I've been trying! :glare:
QuoteHell put a few hospital administrators, CEOs and Insurance company CFOs up againt the wall and see prices tumble. :pitchfork:
One things for certain a political establishment awash with medical lobby money won't do anything, substantial to change these rotten boroughs.
Exactly. And that's the problem. I firmly believe that lobbyists are the biggest problem our country faces. Get rid of them, and we stand a chance at moving into the 21st century.
We can't force them to charge less because the demand for their services far outstrips the supply and there are a bunch of geographical monopolies out there.
We can make medical and nursing schools cheaper, faster and more numerous, trustbust the AMA, lower credential requirements, give all patients a reason to care about their health expenses, allow medicare to negotiate prices for every single thing it pays for and find some way to get malpractice insurance costs down. Maybe some version of the Samaritan Law modified for responders and care providers would be good.
My brother in law is an EMT, and gets elderly people and drunks call for ambulance rides because they're lonely and want a free meal at the hospital. Medicare pays for that BS. They need an incentive to quit that somehow.
Maybe set up some loan guarantees for startup clinics and other hospital alternatives to get the patients with the less intensive needs met more cheaply.
Just brainstorming here.
Lobbyists are merely representing the legitimate political views of concerned citizens, and transmit those views to their elected representatives.
She sounds communist. BURN HER!
Quote from: Tonitrus on February 22, 2013, 10:08:50 PM
Lobbyists are merely representing the legitimate political views of concerned citizens, and transmit those views to their elected representatives.
Getting rid of lobbyists would accomplish nothing by itself. It's a neat a populist battle cry, but after get rid of the lobbyists what would you actually do? What sort of law are they blocking? It would seem to me that the market mechanism that keep prices competitive don't work here. The costs are opaque, the hospitals often have a monopoly, and people rarely have the chance or ability to compare prices.
Damn Raz, I was going to post more or less the same thing. :mellow:
well we are all yi.
Quote from: Berkut on February 22, 2013, 08:59:17 PM
The question is: What do we do about it?
Get rid of the capitalist system or accept a more comprehensive solution of Obamacare (he's one of the few US presidents in recent History that actually cares about you, believe it or not), or move to Mexico. What you should *never* do is leave health in the hands of the private sector.
In continental Europe, the State covers most of the Health costs, so the vast majority of people don't have to worry much about that. And the poorest pay nothing.
Of course, this does not prevent greedy pharmaceuticals or doctors from trying to abuse the system, but then they mess with the State, and sometimes things don't turn out very well for them (we have going an investigation on abusive price-gouging and fraudulent medical prescriptions).
Naturally, Liberal criminals keep trying to privatize Health (many public-private partnerships to run hospitals were made in the early 2000s over here), and the end result was that those hospitals started to lose a ton of cash - as private managers lined their own pockets - and then demanded the State to cover their losses; in fact, a rather sizeable chunk of our debt problem comes from the wonders of 'private management' - both hospitals and banks.
The solution is to join the medical-industrial complex, make a lot of money, and then retire early.
No country has found a solution to healthcare costs. Most of the rest of the world, at least the countries people worth anything live in, have some form of either government provided or government paid-for care and that obviously reduces total societal spending on medical care. However, it just reduces it relative to the United States.
Medical care is so much more expensive here because we have private consumers who use an intermediary to negotiate pricing and such, and thus the costs of treatment are opaque. No cost benefit is given in regard to tests and etc. Doctor's have little incentive to not load patients up with a huge number of very expensive tests. The U.S. and Japan have by far the largest per capita number of expensive, multimillion dollar diagnostic machines. All those machines represent massive capital outlays by hospitals and medical practices that have to be recouped in a reasonable amount of time for those outfits to keep running. Note we have far more diagnostic machines per capita than Canada or Europe but our national health isn't better to show for it.
That's not the entire problem, but it is an example. Since the costs are opaque to the user, we don't care about the excessive spending on diagnostic machines. When the entity paying is the government operating without a profit motive they have a stronger incentive to question unnecessary testing. All the claims administration and etc that is involved in dealing with the insurance middle man is also estimated to take 8-10% of total healthcare spending that wouldn't exist in a different type of system.
All that being said, if we just changed to the system the Canadians and the UK used would our healthcare problem be fixed overnight? Nope, not at all. Every modernized country on earth is facing rising medical costs, that are rising significantly faster than inflation. Anytime the cost of something is consistently rising faster than inflation it is a long run problem, because it means it will take up ever more of societal spending and start squeezing other things--especially when that "something" is the kind of thing people will forego spending on just about everything else (other than food) to purchase.
So there are two issues, one is specific to the U.S., and that is why when you combine government and private outlays do we pay more per capita than any country in the world for medical care. The answer is tied up in excessive billing behaviors by physicians who have a profit motive to push for as many optional procedures, diagnostic tests and etc as humanly possible and an inefficient insurance system operating as the middle man. We might get close to other OECD countries in total spending if we eliminated that, but the problem would still remain that all OECD countries are seeing the cost of medical care increase faster than inflation. That's a much tougher problem, and one that doesn't have easy answers.
[I will quickly note with the global recession medical care proved itself to not be totally recession proof, I believe some of the past few years actually had medical care costs drop in the OECD for the first time since basically 1980, but the long run average increase greater than inflation appears to be back and not likely to go away, so it is a fundamental problem all societies are going to have to address going forward.]
Some key questions globally on medical costs rising faster than inflation we have to answer:
1. World population has grown substantially since the 1970s. Likewise, medical subspecialties have expanded dramatically. In 1970 many specialists were very niche parts of the workforce and most people only regularly interacted with a GP. Now, many people deal with multiple specialists a year, and the growth in demand for all physicians has grown faster than the population. Yet, in the West very few new medical schools have opened since the 1970s. In the U.S. in particular I believe none have opened since then, and the existing ones have only marginally increased their student class sizes. Why isn't more being done to expand the supply at least so that it matches population growth? Note that with the growth in specialization and demand for specialists since 1970, we actually need more doctors overall since 1970 because of a larger population, but we also need more per capita, and the production of new doctors has not kept up at all.
2. In pretty much every other industry I can think of technology has done one of two things. One, is make stuff just plain cheaper in absolute terms. Food is a good example of this, it is a much smaller share of household budgets now than ever before, and is by and large much cheaper than it was 100 years ago. The other alternative is technology will create a better product for around the same cost. Cars inflation-adjusted are about as expensive now as they were in the 1980s. Part of that is because the car makers don't want them to get cheaper year-to-year, but at the same time technological growth and public demands (as well as government regulations) has meant car makers have to deliver "more car" for the same price. In 1980 only the nicest cars had safety features that are 15 years out of date now, many were sold without power windows, without air conditioning etc. Now, even sub-$20k cars are very safe, with side-curtain airbags, antilock brakes, etc. They have more creature comforts too, with Bluetooth, in car navigation, climate control, power windows etc. Cars may not be cheaper than they were in 1980, but we get a much better, safer car than we did in 1980 for the same inflation-adjusted dollars.
Medical care hasn't worked that way at all. Every new technological innovation has straight-line increased costs, period. Technology doesn't make care cheaper or give us more for the same money--it gives us more for more money. An unsustainable trajectory.
And certain types of care are going to rise even more sharply as more folks get old. In countries with non-barbaric health care, you won't see the costs rise. What you will see (and are already seeing) is longer wait times. Sugeries for joint repair or replacement, for example, has started to have some long wait times. Everyone is starting to get them, and with the times being what they are the government can't just outlay millions of dollars in capital the way the private sector can for more operating theatres. Private clinics could open offering those sorts of treatments, but for what the government would pay them, would it be economical? We've established that market forces simply cannot work with health care. Sure, the socialized system is objectively better than the US disaster, but it's also inflexible and unresponsive. Perhaps a blended system would work even better. The only question is how would you put the system together so that it would blend the affordability and morality of the social system with the flexibility and availibility of the private one?
QuoteWhy isn't more being done to expand the supply at least so that it matches population growth? Note that with the growth in specialization and demand for specialists since 1970, we actually need more doctors overall since 1970 because of a larger population, but we also need more per capita, and the production of new doctors has not kept up at all.
That's interesting, because it's a different situation here. The media here always complains about a lack of physicians, but when you actually look at the numbers, the amount of physicians has grown a lot here. Back in the 1960s, we had just 70.000 doctors, 1990, we had 230.000 and now we have 340.000. That's with very limited population growth. However, the number of general practitioners has actually shrunk in the last 20 years, specialists have almost doubled. And doctors in general have concentrated in the cities. So we don't really have a lack of doctors, it's just that the incentives for them to work where they are needed the most are lacking.
Actually a few EU countries have medical costs that are rising but in-line or lower than inflation. In the Netherland were they've a private system (though heavily regulated) costs have started falling recently.
Also the US health system pays way over the odds for most medical procedures compared to any other system.
Since Germany is so small, couldn't people just commute for their medical needs?
Quote from: Neil on February 24, 2013, 01:45:45 PM
Since Germany is so small, couldn't people just commute for their medical needs?
Based on anecdotal evidence, the average age of patients at general practitioners is about 75, so they are probably not particularly mobile anymore. But yes, of course they commute. I think the health insurance pays for taxi rides etc. when necessary.
I tend to think the best, workable system would be similar to the Canadian one...state-funded basic care (delivered mostly by private providers), but also unrestricted private care (for those willing to pay and avoid "waiting lists".
Bureaucracy is unavoidable, of course, but handing it all over to the state (as I understand the UK does it), won't work here. And people who complain about socialized medecine in the U.S., we already have it. Medicare/medicaid is just a poorly-functioning, half-assed version of it. And giant medical insurance conglomerates aren't really all that useful either.
From reading the Wiki article on Canada's system (not the best source, I know), it seems that the government has price restrictions on private health providers? That seems unnecessary to me...if a wealthy person wants to get quick access to services, and there are providers willing to provide it, why not? Fairness? So what? Wealthy people already get unfair advantages, so trying to lock down health care in that way seems pointless.
And the idea that the U.S. military health system might be any kind of model for socialized healthcare? It is...and an atrociously poor one. If I were the DoD, I'd suggest scrapping the entire apparatus, excluding training hospitals and overseas bases, and let service members in the CONUS get their healthcare from private physicians like everyone else.
I believe most countries restrict the prices of private companies too, I think that's the point the Washington Post blog made yesterday:
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/23/steven-brills-26000-word-health-care-story-in-one-sentence/
Quote from: Sheilbh on February 24, 2013, 01:45:31 PM
Actually a few EU countries have medical costs that are rising but in-line or lower than inflation. In the Netherland were they've a private system (though heavily regulated) costs have started falling recently.
Also the US health system pays way over the odds for most medical procedures compared to any other system.
Well to be candid I'm talking a bit bigger picture, I didn't focus in on Rhode Island for example because I don't know or care what a small subset is doing. In 2012 it was the first year spending as a portion of GDP on health care decreased in Europe since 1975. Prior to that it had risen by an average 4.6% average annual Europe-wide for the decade ending 2009; a rate significantly higher than inflation in recent years which has been at times under 2%.
Quote
Quote from: Zanza on February 24, 2013, 01:48:46 PM
Quote from: Neil on February 24, 2013, 01:45:45 PM
Since Germany is so small, couldn't people just commute for their medical needs?
Based on anecdotal evidence, the average age of patients at general practitioners is about 75, so they are probably not particularly mobile anymore. But yes, of course they commute. I think the health insurance pays for taxi rides etc. when necessary.
Here (http://www.nytimes.com/2010/02/15/education/15medschools.html?_r=0) is an interesting article that highlights some of the craziness. Note that early in the article it is mentioned that between the 1980s and 1990s, only a single new medical school opened in the United States.
It's created a situation where yes, we do get the strongest students from bachelor programs. Medical school admissions basically became so competitive that people generally needed to be in the top 1-2% of their undergraduate college class to have the requisite grades to get in. For many other programs, like Master's of Business Admin, Law and etc, the admissions bodies tend to take into account if you had a harder major. So an electrical engineer would be looked on more favorably than a english literature student with slightly better grades. With medical school, spots had become so competitive that basically only the people with nearly perfect grades in the hardest subjects had much hope of getting in.
The only way to fix an undergraduate fuckup would be to go to graduate school for something else and get perfect grades, and then you
might get into one of four
Caribbean medical schools that have lower admission standards than the U.S. but meet criteria such that their graduates are allowed to go back to the U.S. and take the MCATs and get licensure. These Caribbean schools are mostly made up of Americans who just barely couldn't get into medical school.
It's a crazy system--yes medicine is hard and smart people should be selected to follow that path, but it's not so hard that we can only safely allow the top 1% of students into medical school. It's also not the case any student who got a few low grades in four years of college is too stupid to be a doctor.
Here is a comparison of growth of healthcare costs:
(https://languish.org/forums/proxy.php?request=http%3A%2F%2Fwww.ovs.ch%2Fdata%2Fimages%2Findicateurs%2FCouts%252520de%252520la%252520sante%2FCouts%252520en%252520Suisse%2FVersion_D%2FDPart_PIB_OCDE.jpg&hash=3122a76e4c6e38484b9a4e3c29b95cd03f980b3e)
Frank has his own empire now? Wow, I didn't think that guy would amount to anything!
He had his own empire since 843.
Quote from: OttoVonBismarck on February 24, 2013, 04:00:50 PM
Well to be candid I'm talking a bit bigger picture, I didn't focus in on Rhode Island for example because I don't know or care what a small subset is doing. In 2012 it was the first year spending as a portion of GDP on health care decreased in Europe since 1975. Prior to that it had risen by an average 4.6% average annual Europe-wide for the decade ending 2009; a rate significantly higher than inflation in recent years which has been at times under 2%.
Which is fine, but the policies that are put in place in Rhode Island or the Netherlands provide useful lessons for anyone else. Maryland's an interesting example in that article I posted. But I think from an EU perspective the Dutch, heavily regulated, privatisation model is interesting.