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Why Medical Costs Are Killing US? A must read…
[link=http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/]http://healthland.time.co…-bills-are-killing-us/[/link]
I recommend reading this as long as it may be! Definitely some errors and inconsistencies, especially a lack of clarity on where non-profit operating margins actually go, but on the whole hits the jugular. I love the irony of the constant references to McKinsey researchers, a consulting firm that works to help all of Brill’s “offenders” (hospital systems, pharma, device makers, PE, even the frickin government) maximize their returns in current system. “Don’t hate the playa, hate the game.”
Enjoy!
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80 Replies
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Good article. The author is perhaps a little too sanguine about Medicare controlling costs. Medicare is the beneficiary of cost shifting by hospitals, which contributes to the crazy charge master fee schedules of hospitals. If Medicare for all was instituted (as Brill suggests) the per capita costs to the government would increase (or waiting times and rationing would become much greater).
But the article is otherwise an excellent analysis of the many problems in our system. It is important for the public to be aware these “not for profit” hospitals are anything but. And it does a good job of pointing out the developing problem of consolidating hospital systems which will lead to excessive negotiating power on the side of hospitals, ultimately leading to escalating insurance premiums despite the passage of Obamacare. This is a topic largely ignored by most of the press.
I did note he confused a myocardial perfusion scan with a CT scan, but otherwise Brill did a good job of getting his facts straight.
Some examples of hospital administrator compensation quoted in the article are really unbelievable.-
Elegiac, when you say negotiating power, what exactly do you mean (that would increase premiums)?
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Quote from Cigar
Elegiac, when you say negotiating power, what exactly do you mean (that would increase premiums)?
From the article:
[i]Insurers with the most leverage, because they have the most customers to offer a hospital that needs patients, will try to negotiate prices 30% to 50% above the Medicare rates rather than discounts off the sky-high chargemaster rates. But insurers are increasingly losing leverage because hospitals are consolidating by buying doctors practices and even rival hospitals. In that situation in which the insurer needs the hospital more than the hospital needs the insurer the pricing negotiation will be over discounts that work down from the chargemaster prices rather than up from what Medicare would pay. Getting a 50% or even 60% discount off the chargemaster price of an item that costs $13 and lists for $199.50 is still no bargain. We hate to negotiate off of the chargemaster, but we have to do it a lot now, says Edward Wardell, a lawyer for the giant health-insurance provider Aetna Inc.[/i]Read more: [link=http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LZKVix4r]http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LZKVix4r[/link]
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Definitely a must read for everyone. Amazing article.
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pretty biased article from a guy with some obviously preconceived notions about who he thinks are the good guys and bad guys in healthcare…
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He may be biased but it still a good point that a CXR shouldn’t cost a patient more than $100 just because they are paying out of pocket.
There is no such thing as a free market in medical care.
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one can take select facts and make a persuasive case about a lot of things. he does more than this though, and makes many unsubstantiated claims and not even close back of the envelope calculations.
i’m no fan of hospitals and their growing market clout, but when he paints aetna as a sympathetic figure, it’s laughable.
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Give me immunity from malpractice suits and I guarantee you I can cut the cost of imaging by >50%.
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Wow. A must read for sure.
This is not right.
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This has nothing to do with malpractice insurance. This is not about doctors fees. This is about everyone else who got into the medical game when Ronald Reagan deregulated the industry, and said (paraphrasing) “we need to let business people run medicine like a business, and let doctors do what they do best – treat patients.”
The truth is, medicine is a sure bet in the world of business. People will do anything, pay anything to buy it. That’s why they turned it into a corporate-run, Wall Street traded commodity – it’s a can’t-lose proposition. I call it blood money.
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Quote from Loudog
one can take select facts and make a persuasive case about a lot of things. he does more than this though, and makes many unsubstantiated claims and not even close back of the envelope calculations.
i’m no fan of hospitals and their growing market clout, but when he paints aetna as a sympathetic figure, it’s laughable.
I didn’t get the sense he was overly sympathetic to the insurers. I think he was simply pointing out the hospitals and insurers are both part of the problem, trying to squeeze each other for the most money.
The whole point is the real losers are those people who are not sufficiently destitute to qualify for Medicaid, nor fortunate enough to have gold plated insurance policies to cover the costs of catastrophic medical expenses. It is these unfortunate people who the hospitals basically screw over, while they cut deals with the government and insurers.
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Patient’s who don’t have insurance should never set foot in a Private hospital. They should have gone to a county state funded hospital.
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I certainly agree that there are huge issues with the current system and it screws over the self pay patients. That being said, a significant part of the problem is the American people and their expectations. The guy in the story is from Ohio, but ‘had’ to go to md Anderson to get care. There aren’t any closer/more affordable hospitals that have rituximab?
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Well…. I bet he could have gone to the Cleveland Clinic and written the identical story.
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Quote from radiohead101
Patient’s who don’t have insurance should never set foot in a Private hospital. They should have gone to a county state funded hospital.
And what makes you think things are clearer there? If you think reimbursements are difficult to understand, try consumer shopping as a patient. You will find the for profit hospital down the street saying in their Mission Statement they are there for you, but it won’t say, “Only your empty wallet stands between you and treatment.” Even Community Hospitals or Medical Centers with St. Saint names are complicated. Go price a simple radiology procedure between 2 similar institutions – if you can before the fact. The cash price might be say $200 and if you have insurance it might be $100 out of pocket but if you have insurance the insurance company might pay out $1,000 for that procedure. But as a consumer you won’t even be able to find out that out of pocket expense.
It makes your head spin. Even we in the field don’t comprehend the issue. Mostly we know reimbursement, little more. -
I thought this author did an excellent job, showing the pluses and minuses. It was a perfect piece, but still a good one.
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I will be willing to bet that if you check the self pay rates at even your hospital they are way out of line. I know that we set our own rates artificially high because insurors ask for them and if low they won’t give us close to what is reasonable (the 1.3 -1.5 Medicare that article mentioned). Prices are a game. The problem is being stuck in a self pay position. If this couple had gone to where they accepted the insurance the rates would have been much lower.
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There is a definite slant but he did try to highlight where others including pharma are trying to help. The bottom line is that the markups for self pay are insane and driven by other factors. Seems like you could cap self pay charges at 2x Medicare and I bet there would be better pay compliance and save the fees of the bill collectors, court costs, attorneys, etc
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You often don’t know how badly you can be burned until you actually are. I didn’t realize the price difference until I got burned, not terribly badly but enough to make me sit up and notice, but that was already after the fact. When I had tried to get costs before they were incurred I could not, cash price is the best I could do.
Prices and costs are protected from being public information. -
One aspect that stands out to me
1) relying on self pay without negotiating a priory the cost is an awful way to go. I knew this from trying to price out more minor “medical procedures” in the past for friends — leg DVT study.
2) The fam did not have to go to MD Anderson. You can’t be both a beggar and a chooser. The much more sensible thing would have been to call hospitals and come up with a different plan. There is nothing magic about the MD Anderson people when it comes to lymphoma treatment. It’s the smokes and mirrors. Lymphoma tx in general has good survival and this isn’t a disease which is so rare, that only one institution has a “lock” on treating it properly.
Does anyone thing the person could not have gotten the -imab therapy somewhere else? i would be surprised, though not shocked, it the pt would not have been able to get the tx elsewhere @40 discount from what he paid if homework/negotiation would have taken place. Though i could be very wrong…from a hospital business perspective, why wouldn’t i take someone willing to pay cash and still give me a huge profit.
3) This bullshit about mid level managers making 500k and hospital CEOs making 1.8mil/yr has to go. CEO can get paid at the level of avg pay of 5 top paid physicians. not triple or double. mid level managers? are you kidding me? 200k max. and no more than 3-5/system. -
The only point I would make about MD Anderson…many businesses would actually help you find a place where you can afford a product rather than put you in the poorhouse. Idealistic yes, but there is no reason they couldn’t have said your insurance won’t cover things here you may want to go to a more local place that can do the exact same thing (and maybe they did and the family didn’t listen)
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Brill was on John Stewart last night. Nice to hear him say that it was not the doctors and nurses salaries that were breaking the bank
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A perfect example of the uber confused liberal-types that complain about markets, when in reality the intervention of government has totally ruined the market. Again, it’s not about markets being the problem, it’s government. Intervention and political gaming is FAR worse than a nationalized system. One generation of doctors got rich (and hospitals are still) and now everyone else is paying for it, literally.
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Quote from Cigar
A perfect example of the uber confused liberal-types that complain about markets, when in reality the intervention of government has totally ruined the market. Again, it’s not about markets being the problem, it’s government. Intervention and political gaming is FAR worse than a nationalized system. One generation of doctors got rich (and hospitals are still) and now everyone else is paying for it, literally.
Well said. Whenever the govt touches anything, price goes up and quality goes down. Education is a perfect example.
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This.
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Yeah the article is 10 years old and the original link migrated. Here is a pdf: [link=https://bioinformatics.tech.purdue.edu/458/bitter_pill_paper.pdf]https://bioinformatics.te…/bitter_pill_paper.pdf[/link]
And a link to the new location on the Time website: [link=https://time.com/198/bitter-pill-why-medical-bills-are-killing-us/]https://time.com/198/bitt…-bills-are-killing-us/[/link] -
Can someone explain this to me? Did we basically make all these claims for prestige or (more likely) billing reasons? I don’t understand the neuro followup for stroke, given the low probability it changes management at all. For example, for late 80s or 90 yo patients, once a non con head is negative, is there really anything (truly, come on, be realistic here) to do, that couldn’t also be similarly just remedied by IV tpa if that was your deal?
We do routine CTAs on people of these ages where most are negative, like 90+%. Let’s say a random one gets a hit, and some circle of willis, let’s say it is an MCA branch that’s like 1mm, doesn’t get contrast/is “occluded.” Are they really going to do anything with that, and if not make it worse jigglin that small catheter around if they can even get there – will it even have a chance in Hades of even getting better? I find this impossible to believe, beyond what a waste of resources it is …
I see 5th study neuro MRs that just saw us DWI in some small basal ganglia structure, or caudate, or something, and just laugh all the time. All of that … and we still just watch the patient. Hmm -
Evil intervention has only reduced mortality. Too expensive.
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That is a very informative article.
What is happening to many patients is not right. When some people, i.e. the ones that make 2 to 5 million dollars a year, catch glimpse of a patient coming through the door, apparently their only reaction is “Ka ching!”
We are such small fish and grunts enabling the people who can’t do the work but take the credit and glory (not that that’s what medicine is all about):
“In fact, Gilbert [the ER patient] 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.[/b] (Medicare would have paid about $825 for all three.) A doctor charged $261 to read the scans.”[/b]Read more: [link=http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LftZJrK1]http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LftZJrK1[/link]
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That article should be required reading for all in the healthcare field. Especially ER docs.
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The ER orders way too many studies. Trauma team too. Hardly any patients can afford it, at my hospital. Most are homeless, bordering on homeless, or gang victims. It’s a boon to the admins but a disaster all around for the patients.
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Cigar…what govt intervention is allowing for a 75% markup on a spinal stimulator?
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Quote from Thor
Cigar…what govt intervention is allowing for a 75% markup on a spinal stimulator?
Thor, look at the big picture. Is the markup stuff totally ridiculous? Absolutely. And it’s not about “allowing” anything it’s about intervening in a market which then causes the market players to do all sorts of stuff in order to get paid a certain amount (the most they can). This gaming/manipulation ultimately hurts the people the government players intend to protect, although I don’t even think they intend to help/protect them, they just want their votes and when the money runs out, they say “too bad”.
In a real market there would be a cost and someone would pay it, or he wouldn’t. And the company charging that would get paid, or go bust. It’s very simple. -
The point is that you would have REAL prices like you would anywhere else. None of this fantasyland stuff.
That’s what is so ironic. Everyone is complaining about the cost and wants to have a 3rd party pay for it, yet in reality that makes it worse for every last person when push comes to shove!!!
… then … more complaining when the whole situation is patently obvious. -
Last year I switched over to a high deductible plan from the traditional plan. (Our hosptial offers significant monetary incentives to go to the high deductible in addition to the significantly reduced premium.)
My wife needed an U/S pelvis. We were charged the sefl-pay rate set by my own department ………. $2800!!!! Our responsibility was $1400. -
Cigar there is nothing preventing hospitals from publishing prices and no prohibition on publishing them. How is the govt responsible for a 75% markup? Can you call local hospitals and get pricing for the procedure and are you given a choice of which specific device? Can you choose between the medtronic v. Boston Scientific device for example. Are patients offered a variety of different central lines to choose from with costs?
Would the absence of Medicare and Medicaid make health care more or less affordable?
The point of the article is to arrive at a discussion of transparency and reasonable charges. Unfortunately you can’t comparison shop when you are having a heart attack or stroke -
I just can’t believe it !
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Quote from Cigar
The point is that you would have REAL prices like you would anywhere else. None of this fantasyland stuff.
What are REAL prices? What would REAL prices be without government subsidized health care? Would that automatically ensure a consumer market where consumers could honestly evaluate cost and return and quality of care? Like a Consumers Report of health care for instance?
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Quote from Weekendwarrior
The ER orders way too many studies. Trauma team too. Hardly any patients can afford it, at my hospital. Most are homeless, bordering on homeless, or gang victims. It’s a boon to the admins but a disaster all around for the patients.
The ER is evaluated by how much business it creates through orders & admissions.
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Quote from Loudog
i’m no fan of hospitals and their growing market clout, but when he paints aetna as a sympathetic figure, it’s laughable.
This
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I read this article two days ago and I’ve been thinking a lot about it since. It has a lot of people talking, so I guess that’s a good thing. I agree with many of the above posts- this is an overall good piece, and the author seems like an honest man on his Daily Show interview. What happened to some of these folks is awful, but I have a few points against the whole thing.
1. Once again, we are being swayed by outliers- the several stories here are bad, but they are uncommon. Most people will run into a high medical bill in their lifetime, (my daughter spent a month in the ICU, so I know about that) but it doesn’t usually result in this sort of ruination. Hospitals (except MD Anderson I suppose) will work with you when it comes to billing, and the payment plans are reasonable. Most of the folks in the article reached some sort of tolerable agreement in the end. This reminds me of the healthcare debates of 5-6 years ago, when stories like this were bandied about to convince us that the system was broken, when really it was only broken for the few. I submit that a system which works well for 90% of the population is not broken, and never was. It could be improved upon, and hopefully some of the beneficent changes from Obamacare will achieve a better percentage.
2. While good intentioned, I can’t help but see some of the usual bias from non-healthcare folks which always gets my dander. Example- “we spend more on ambulance transportation than we do on Hollywood!!!” My response- so what? So we spend more money in emergency medical transport than we do movie entertainment, is that such a terrible thing? This reflects the widely held but rarely spoken belief that we should have excellent medical care (ambulance rides and CT scans for a broken nose, for instance?) without paying top dollar for it. The phrase, “affordable, quality health care” rings like tin in the ear. People want our services, our extensive training, they want us awake at 3am to read their face CT, but they do NOT want to pay for it. And they fully intend to use the tyranny of the majority to legislate us into servitude, so they can return the balance of power back to its proper position- where entertainers are rich, and doctors are monks.
3. “60% of bankruptcies in the US are health-care related”- spouted off again, and again, and again. I’m no finance expert, but I have known friends and family consider bankruptcy and in one instance actually file, and I think it is uncommon that one single source debt can cause a bankruptcy. I would submit that in most of these instances that medical debt is just a component, perhaps the largest one, of a person’s financial ruin. Perhaps if they had spent, or saved, money in other ways they wouldn’t have found themselves in the situation. Or perhaps if they didn’t HAVE to go across the country to MD anderson or Sloan for routine lymphoma treatment, or perhaps if they didn’t HAVE to spend themselves into oblivion to get every last moment they could from their stage4 lung CA diagnosis they wouldn’t face these circumstances. There are multiple examples in this article where the “victims” made a number of terrible decisions and are not being held responsible (ambulance ride for a bonk on the head, for example.) I’d like to know the real numbers here- how many of these folks are there, really? How many of them had other significant debts? How many of them had aggressive end of life care?
4. Tort reform is inadequately addressed. Period. Until you unshackle the ER docs from this potential hazard, they WILL continue to order CT head, face, c-spine for somebody with a broken nose. It’s not their fault- the patient is in hysterics, “everything hurts”, there are distracting injuries, blah blah blah. CT it all. I would do the same thing.
Sorry for the long post. I have more thoughts, but I should curb it now.-
Agree with much of what you say. People demand the best 24/7 but do not want to pay. Sure things in the hospital are marked up. From what I have always heard, that is to cover for those who do not pay at all. The problem is that the uninsured do not get in on the negotiation power of insurance and end up screwed.
There are two things I wish authors such as this would touch on (aside from the obviously desperately needed tort reform and end of self referral):
1. We are always told by media “studies show we pay so much more but are worse off than other countries.” If you are going to continuously make this claim, tell us where you evidence comes from so we can review these studies. I would imagine many either make no attempt or a poor attempt to control for our obesity rate, for example, and these confounders simply must be taken into account. Dies anyone here have links to any of these studies that show how bad US healthcare is?
2. Educational debt: no one cares about the debt incurred by medical professionals. A medical debt of 200,000 USD may bankrupt many of these people who are complaining. These people want the access to the best doctors 24/7 but want to not pay anything. Many of the angry people discussing the article on CNN say the system is messed up because it should be a public service and not an industry. The problem is they don’t want to have health care professionals paid what they are paid, but the also don’t want to pay or our education by means of higher taxes for them and they want the best doctors which have to pay a lot of money for school. No one talks about this. Moreover, when people talk about mean debt, it seems to give an underestimate for true debt burden. The mean takes into account outliers who have either parents or scholarships paying for some or all of their tuition. We had a number of those in our class who brought down the mean number to a number that was not as high as it should have been, but was still high enough to bankrupt many of the people talking about these absurd medical bills.
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The mortality figures in the US are the worse than most industrial countries for three reasons. All are elephants
1) Obesity — there is so much industry money that promotes behavior and profits from obesity that every time some sort of TAX is brought on products that contribute to obesity you have
a) STOP GOVT FROM INTERFERING with our lives debate
b) THIS WILL LEAD TO MASSIVE JOB LOSSES
2) Teenage pregnancy and perinatal mortality. This is a country where it’s acceptable to deliver a 24 week premature baby and spend 800k on “treating” the baby Many of these babies ultimately die. In other 1st world countries, no such attemp is made. This markedly increases the “mortality” rate in the US
b) it is much more acceptable in this country to get pregnant at 13-16 and not deliver the baby. These babies, for a combination of reasons including drugs, alcohol, lack of prenatal care and so forth don’t do as well– increasing mortality
3) HOMICIDE: life expectancy in the US is always weighted down by much higher homicide rates in the young population
STRIP THESE 3 FACTORS or even just two — homicide and teenage pregnancy and the US #s look remarkably similar or better than other industrial societies. Strip out the 40% obesity and 20% morbid obesity and we are well ahead.
Essentially, there is a comparison of apples and oranges when these statistics are given. This is why “adults” from other countries come here for healthcare. Once you make it to 35 in the US, your chance of living a long life span are no longer worse than Germany, Finland, Norway.
4) This is still not proven beyond doubt but living a rich social life prolongs how long one lives. This is much easier in countries where one can’t live 3000 miles away from family. This is also not accounted for by “studies on average life span”-
Essentially, there is a comparison of apples and oranges when these statistics are given. This is why “adults” from other countries come here for healthcare. Once you make it to 35 in the US, your chance of living a long life span are no longer worse than Germany, Finland, Norway.
Actually the bigger elephant is why given the differences in expenditures do we do no better than “socialized” medicine countries even once you control these factors. Meanwhile except for a select few there is not a lot of folks pounding down our doors from Europe for treatment (they can’t afford it) and one of the biggest growth industires in medical tourism for US citizens to get treated in other countries at lower costs-
Props to Norma Ray, Wisdom, Thor, and others like minded.
Must read article. Thanks to OP for posting.
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Thor, please read and understand, again, please re-read: Hospitals are NOT involved in a market and therefore they treat the issues differently. Period.
Wisdom is right on. I’ll add that at point of intervention, US is #1. Like he says, if you would rather be treated in another country over the US, given the choice as an adult, you’re just a liar.-
Cigar
when in reality the intervention of government has totally ruined the market. Again, it’s not about markets being the problem, it’s government. Intervention and political gaming is FAR worse than a nationalized system
This presumes two things that a free market system is able to exist for healthcare and that the govt has dismantled it. Neither are true. Now in some discretionary spending areas where you can comparison shop (aesthetic plastic surg) you can comparison shop; but for most medical procedures this does not exist and probably cannot reasonably exist because of the nature of acute illness.
The other interesting point several has made is that socialized medicine does not perform better. The more important point is that it performs equal at more than half the cost-
All these conclusions about US healthcare better are made in a vacuum. How so, what criteria? Quality? Many countries are easily our equal in many areas especially in regards to cost and who can be treated is not a factor. We do better in some areas but “they” do better in others. As the article points out, bankruptcy is a consideration.
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Quote from Thor
Cigar
when in reality the intervention of government has totally ruined the market. Again, it’s not about markets being the problem, it’s government. Intervention and political gaming is FAR worse than a nationalized system
This presumes two things that a free market system is able to exist for healthcare and that the govt has dismantled it. Neither are true. Now in some discretionary spending areas where you can comparison shop (aesthetic plastic surg) you can comparison shop; but for most medical procedures this does not exist and probably cannot reasonably exist because of the nature of acute illness.
The other interesting point several has made is that socialized medicine does not perform better. The more important point is that it performs equal at more than half the cost
A free market can exist for healthcare. Whether anyone would allow it is another issue.
Socialized medicine indeed has its benefits, especially compared to “no man’s land” systems like ours in the US. I have and always will agree with you on that. I’m not sure it performs “equal” though. In situations, it can be fine. That’s dependent on point of view as well (maybe that’s the most important thing, not to have crazy expectations like Americans do).
Thor, I’ve gathered your rather left leaning. Have you ever spoken out on how ludicrous the legal system is in this country (which is nonexistent, essentially in health care with nations of socialized medicine)? Will you call out Democrats (not calling you a Dem) for making this discussion of more governmental control without controlling lawsuits a mockery by willing omission?-
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Thor, I’ve gathered your rather left leaning. Have you ever spoken out on how ludicrous the legal system is in this country (which is nonexistent, essentially in health care with nations of socialized medicine)? Will you call out Democrats (not calling you a Dem) for making this discussion of more governmental control without controlling lawsuits a mockery by willing omission?
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it’s interesting that people who believe that socialized HC systems are superior to our current system rarely mention the uniqueness of our medical-legal environment…I can only assume that they either believe 1). Our physicians are so incompetent that patients need to be protected from medical malpractice. 2). Our patient’s are somehow intrinsically more vulnerable to medical malpractice that patient’s in socialized countries and therefore need to be protected.-
Yes I 100% agree that the way forward includes protection from lawsuits if following appropriate guidelines and if you were to socialize medicine or go to single payer or work out cost controls you must change the medico-legal system. Perhaps if we had European style medicine from the outset we wouldn’t have the medical-legal problem. At a minimum we should switch to medical courts not leave it to the whim of lay people
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The big problem is that health care is not in the same universe as a free market. Free markets depend on everybody having all the information and being able to act on it. In health care nobody has all the information. All have just small pieces of it. A patient when having a heart attack can’t compare prices. For that matter it is practically impossible to keep good data to compare prices at the best of times. There is virtually no way to compare quality especially of doctors. Rules of supply and demand don’t work when those that control supply can also control demand. We need to stop thinking about health care like any other industry and take it for what it is.
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You don’t want socialized medicine.
You don’t want to be sued.
You don’t want to believe the bankruptcy statistics.
You don’t relate the the masses of people suffering under this medical system.
How many medical practices do you own?
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This is not an eye opener. We knew this. We all did. Nobody wanted to talk about it though. After all, we get paid through this system. American healthcare in the current form cannt last. It is built on weak legs, which means our legs are weaker as well. …Lets see when this one crashes……….
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It is not the government and “socialism” preventing the public from knowing the costs and fees involved in a patient’s diagnosis, care and treatment, it is the private sector. All of the government information is publicly available, it is the private agreements that are not available to patients for comparison shopping.
In fact we will all know we have really reached a market-based system when there are ads for “buy one, get one free!” We are already advertising so discount sales could be next. Coupons?
I’m only half joking.
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[left]A good start towards something a little closer to a free market in medicine would be to have the feds enforce antitrust laws regarding the huge differences in charges to different individuals for the same service at the same hospital. What other industry is allowed to charge different individuals such disparately? Who doesn’t think that if some people were being charged $150,000 for a new car and others $40,000, that there wouldn’t be a huge consumer outrage? I imagine there might even be charges of discrimination.[/left]
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You can never have a free market in medicine. That’s why lawyers and Wall Street are all over it.
We need socialized medicine in America, just like every other civilized society in the world.
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Quote from Nabdul
[align=left]A good start towards something a little closer to a free market in medicine would be to have the feds enforce antitrust laws regarding the huge differences in charges to different individuals for the same service at the same hospital. What other industry is allowed to charge different individuals such disparately? Who doesn’t think that if some people were being charged $150,000 for a new car and others $40,000, that there wouldn’t be a huge consumer outrage? I imagine there might even be charges of discrimination.[/align]
That doesn’t make the case for anti-trust. The Feds need a case before they can pursue it. At least I am not aware of evidence to make an anti-trust case. Others would call it the free market since each can negotiate and set its own prices. You CAN buy the same car for very different prices. The major difference is you can know the price of the car BEFORE you buy it.
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Quote from Frumious
That doesn’t make the case for anti-trust. The Feds need a case before they can pursue it. At least I am not aware of evidence to make an anti-trust case. Others would call it the free market since each can negotiate and set its own prices. You CAN buy the same car for very different prices. The major difference is you can know the price of the car BEFORE you buy it.
I have no doubt the FTC is holding strategy sessions concerning future antitrust regulations for hospital systems and related entities once the ACA has been fully implemented. I attended a hospital leadership conference a year ago at which a speaker – supposedly a big wig DC attorney in the know regarding health care policy and regulation – described the turf battles within the federal ranks (for regulatory control) between bureaucrats from FTC and CMS/DHHS.
Presently there is no reason for the FTC to prosecute any antitrust cases against hospitals; their current aim is to allow hospital systems to complete their goal of consolidation. Hospital system consolidation will ultimately facilitate the government’s regulation of the industry. Once consolidation is accomplished, then we will see see federal antitrust action.
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In my area, the hospital mergers/acquisitions and physician practice buyouts by the state’s largest hospital conglomerates have already begun and are in full swing. I’m no antitrust legal expert, but it sure seems to me that they are striving for local monopolies or oligopolies. The current generation of physicians may be able to benefit enough from being bought out to pay off their education debts, but I’m not very optimistic about those who come after, who will have to take hospital employee positions.
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There are hospital buyouts everywhere. Many of those hospitals being bought out are operating in red ink.
Welcome to the future, corporate health care that everyone has said they’ve wanted since the 1980’s. Even non-profits are operating like HCA in order to survive because the model is to allow them to fail and close if they can’t be profitable. Physicians as employees falls into the same area, if you can’t operate independently, become an employee. -
Follow-up – ACR response to TIME Article:
[link=http://www.acr.org/News-Publications/News/News-Articles/2013/Advocacy/20130222-Facts-Incorrect-Regarding-Medical-Imaging-Legislation]http://www.acr.org/News-Publications/News/News-Articles/2013/Advocacy/20130222-Facts-Incorrect-Regarding-Medical-Imaging-Legislation[/link]
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Generaly the charges are all the same. Charges though have no bearing on payments. Hospital charges 2000 for MR knowing that they have contract paying only 300 and rest is by contract not obtainable. I am willing to bet though that if hospital has multiple groups providing same services (say multiple general surgery groups) the charges for the physician portion of bill may vary (payment may as well). This brings up another problem to a market in healthcare. Say you need a surgery. Who do you ask about costs? Each component doctor, lab, anesthesia, surery center/hospital, radiology, etc will all have bills taht only they know the charges for. Also you may not even know what charges there will be. I recently had colonoscopy. GI doc was on plan and had done my prior exam. Went in same as before. They now use nurse anestheist to give profolol. Recieved bill for $600 as their fee because they weren’t on plan. Similrly have seen things such as Ob covered for amnio, but not the lab. The bottom line is that there is virtually no way to determine costs in advance and even less to know what the quality of care will be. If I want a car I know generally what it will cost and know generally the quality and what features it will have. Go get a knee replacement and cost of device alone may vary by thousands of dollars with you having virtaully no say in what is chosen.
The US is not the best at all health care. From what I read if you want the best boob jobs head to Brazil becasue they are covered there and done much more frequently. I am sure that Japan have docs with actually has more experience with liver tumors than anywhere here. I rthink that our care at the best sites is as good as anywhere with few exceptions, but a rural community hospital here isn’t as good as university hospital in say Germany.-
There may be no antitrust basis regarding charges, if the hospital ‘charges’ the same via the ”chargemaster’, even though there are huge differences in the amount billed to different patients, which I still feel is a total travesty. Another travesty as you mention, is the total inability of any patient to determine what his bill will be for any service [i]a priori[/i], even assuming it is an uncomplicated outpatient service. However, apparently federal and state regulators have been finding a basis for antitrust actions against hospitals regarding hospital consolidations and buyouts of physician practices, as in the below article:
[link=http://www.nytimes.com/2012/12/01/business/a-hospital-war-reflects-a-tightening-bind-for-doctors-nationwide.html?pagewanted=all&_r=0]http://www.nytimes.com/20…agewanted=all&_r=0[/link]
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The family is clueless. They could have gone to their local cancer center rather than MD Anderson. They have rituxmab there as well.
It’s like saying I want to UCSF to have my Chest CT read by Richard Webb rather than going to a local hospital.
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Quote from UGaBulldog
The family is clueless. They could have gone to their local cancer center rather than MD Anderson. They have rituxmab there as well.
It’s like saying I want to UCSF to have my Chest CT read by Richard Webb rather than going to a local hospital.
How would the family know that the local CA center was better or as good as MD Anderson? And could they get the costs up front at the local center as well? I doubt it. And there is no way they could do comparison shopping other than by “reputation,” even if overblown, or not. So the criteria is choosing the local over MD is what? Travel convenience & travel cost. But if you believe MD provides better outcomes, what do you do for yourself or family?
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I can tell you that Rick would have that VXR read in about 10 secs. When we had the old rotators he would have the film read before the rotator stopped.
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If anyone is still interested, this podcast relates to the TIME article. It’s interesting.
[link=http://www.npr.org/blogs/money/2013/02/26/172996963/episode-439-the-mysterious-power-of-a-hospital-bill]http://www.npr.org/blogs/…wer-of-a-hospital-bill[/link]-
Why question is when did we all get sold this notion that “the market” can solve all that ills us. The market exists to make money not solve social issues. I hear talk of making public schools compete “in the market” with private schools as a means to make them better. It is nonsense. Every public school would love to be able to compete. That means they have the same rules. They can pick and choose who they educate, kick out any that break the rules or can’t cut it. That isn’t what they are or ever will be. They are tasked to educate all comers. In medicine there is no “market”. With third party payors paying the bills, but not dtermining what or where anything is done you can’t have a ‘market”. Also you have no idea even if you could tell costs (which you can’t) whether you are buying a Yugo or a Masserati. Yes the family could have stayed locally and may have gotten as good care as at MD Anderson, but they have no way of knowing that. I also didn’t hear them complianing about the costs. They knew before hand that they were outrageous. The article wasn’t that they got s****d but that charges have no correlation with costs. When a neural stimulator that costs $500 to make ends up being charged at $49K, you have to admit that there is a problem.
For those that argur that all the studies that show our healthcare isn’t as good as elsewhere, can you show any study that we are 2x better to justify the costs. I have no study at all that shows us better, maybe equal but not better. I don’t know of anybody in any party that thet says our costs are just fine and nothing needs to be done about them.
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disgusting …
[link=https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims]https://www.propublica.or…rance-rejection-claims[/link]
[h1]How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them[/h1] [h2]Internal documents and former company executives reveal how Cigna doctors reject patients claims without opening their files. We literally click and submit, one former company doctor said.[/h2]
The rejection of van Terheydens claim was typical for Cigna, one of the countrys largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for [link=https://newsroom.thecignagroup.com/2023-2-3-Cigna-Reports-Strong-Fourth-Quarter-and-Full-Year-2022-Results-Establishes-2023-Guidance-and-Increases-Dividend]18 million people[/link].
Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.
But the Cigna review system that blocked van Terheydens claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
We literally click and submit, one former Cigna doctor said. It takes all of 10 seconds to do 50 at a time.[/QUOTE]
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We have known this for some time. No one will do anything about this.
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What could possibly go wrong?
Also, a scary preview of how many will desire to deploy AI without retrospective testing and prospective QA. In billing, medicine, and elsewhere-
Quote from NYC
What could possibly go wrong?
Also, a scary preview of how many will desire to deploy AI without retrospective testing and prospective QA. In billing, medicine, and elsewhere
sounds an awful lot like a mass mRNA experimentation on the public …
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Quote from dergon
disgusting …
[link=https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims]https://www.propublica.or…rance-rejection-claims [/link]
Much higher profits when you systematically reject a huge swath of claims without any effort. Weeds out patients who don’t notice or don’t have the time/effort to fight it.
Sprinkle in a bunch of “medical directors” with no shame (and often have been removed from clinical care for a variety of reasons) and there you go.
No surprise here, everyone knows this is how it works sadly.
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Another reason why insurance is a scam
in the advent of ACA, just join later, gub been scammin’ me my whole life, and other people do this anyway, while I’m healthy
when they pay me something for not taking up ANY services because of my health and fitness come talk to me about “insurance” as some sort of “right” (to steal other people’s money)-
Am I the only one who can’t get this article?
I click the link, it immediately redirects to a time.com site, and says I have reached a page that doesn’t exist.
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but when you strip out those factors, countries with socialized medicine don’t do better. that’s my exact point…and if there are differences, they are minor relative to the “current” #s.
you see fat people in europe. but you rarely see 400 lbs…which isn’t that outside the norm here in some cities. same with 300 lbs. it’s fine here to be [size=”0″]big and tall. while this is beginning to catch up in the rest of the world due to the “american culture export” it’s not nearly as acceptable. [/size]
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Quote from kitra101
1. We are always told by media “studies show we pay so much more but are worse off than other countries.” If you are going to continuously make this claim, tell us where you evidence comes from so we can review these studies. I would imagine many either make no attempt or a poor attempt to control for our obesity rate, for example, and these confounders simply must be taken into account. Dies anyone here have links to any of these studies that show how bad US healthcare is?
There are plenty of studies. Even AEI addresses the conclusions although their spin is that the data is analyzed incorrectly. As for obesity, it’s a public health problem & is being addressed from NYC Mayor Bloomberg banning super large sugar drinks to Michele Obama and many others. Articles the other day about how children’s diet and caloric intake is improving.
[link=http://www.aei.org/outlook/health/global-health/us-health-care-a-reality-check-on-cross-country-comparisons/]http://www.aei.org/outloo…s-country-comparisons/[/link]
[link=http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/May/1595_Squires_explaining_high_hlt_care_spending_intl_brief.pdf]http://www.commonwealthfu…pending_intl_brief.pdf[/link]
[link=http://www.nydailynews.com/news/expensive-results-health-care-u-s-costs-best-world-article-1.394841]http://www.nydailynews.co…world-article-1.394841[/link]
[link=http://www.pbs.org/newshour/bb/health/july-dec12/medicine_09-24.html]http://www.pbs.org/newsho…12/medicine_09-24.html[/link]
Quote from kitra101
2. Educational debt: no one cares about the debt incurred by medical professionals. A medical debt of 200,000 USD may bankrupt many of these people who are complaining. These people want the access to the best doctors 24/7 but want to not pay anything. Many of the angry people discussing the article on CNN say the system is messed up because it should be a public service and not an industry. The problem is they don’t want to have health care professionals paid what they are paid, but the also don’t want to pay or our education by means of higher taxes for them and they want the best doctors which have to pay a lot of money for school. No one talks about this. Moreover, when people talk about mean debt, it seems to give an underestimate for true debt burden. The mean takes into account outliers who have either parents or scholarships paying for some or all of their tuition. We had a number of those in our class who brought down the mean number to a number that was not as high as it should have been, but was still high enough to bankrupt many of the people talking about these absurd medical bills.+1 A lot of truth there.
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A quick look at these links shows my point. None are true scientific studies. Most are “experts” on a soap box. The couple that actually cites some stats are interesting. One says that our obesity rate is much larger than all other nations but our population age and smoking rate is not as high as others so that probably counteracts obesity. Great evidence there. The second goes on to show just how flaws the infant mortality rate comparisons are.
Does anyone have a link to a proper scientific paper showing worse outcomes and controlling for confounders such as our crazy obesity rate?
Quote from Frumious
Quote from kitra101
1. We are always told by media “studies show we pay so much more but are worse off than other countries.” If you are going to continuously make this claim, tell us where you evidence comes from so we can review these studies. I would imagine many either make no attempt or a poor attempt to control for our obesity rate, for example, and these confounders simply must be taken into account. Dies anyone here have links to any of these studies that show how bad US healthcare is?
There are plenty of studies. Even AEI addresses the conclusions although their spin is that the data is analyzed incorrectly. As for obesity, it’s a public health problem & is being addressed from NYC Mayor Bloomberg banning super large sugar drinks to Michele Obama and many others. Articles the other day about how children’s diet and caloric intake is improving.
[link=http://www.aei.org/outlook/health/global-health/us-health-care-a-reality-check-on-cross-country-comparisons/]http://www.aei.org/outloo…s-country-comparisons/[/link]
[link=http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/May/1595_Squires_explaining_high_hlt_care_spending_intl_brief.pdf]http://www.commonwealthfu…pending_intl_brief.pdf[/link]
[link=http://www.nydailynews.com/news/expensive-results-health-care-u-s-costs-best-world-article-1.394841]http://www.nydailynews.co…world-article-1.394841[/link]
[link=http://www.pbs.org/newshour/bb/health/july-dec12/medicine_09-24.html]http://www.pbs.org/newsho…12/medicine_09-24.html[/link]Quote from kitra101
2. Educational debt: no one cares about the debt incurred by medical professionals. A medical debt of 200,000 USD may bankrupt many of these people who are complaining. These people want the access to the best doctors 24/7 but want to not pay anything. Many of the angry people discussing the article on CNN say the system is messed up because it should be a public service and not an industry. The problem is they don’t want to have health care professionals paid what they are paid, but the also don’t want to pay or our education by means of higher taxes for them and they want the best doctors which have to pay a lot of money for school. No one talks about this. Moreover, when people talk about mean debt, it seems to give an underestimate for true debt burden. The mean takes into account outliers who have either parents or scholarships paying for some or all of their tuition. We had a number of those in our class who brought down the mean number to a number that was not as high as it should have been, but was still high enough to bankrupt many of the people talking about these absurd medical bills.+1 A lot of truth there.
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I agree this is a must read. It has not yet hit the news stands, but it’s available online today at [link=http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/]http://healthland.time.co…-bills-are-killing-us/[/link]
For decades, every time the high cost of medicine it brought up, everyone loves to point to MRI and Radiologists, when in fact, we have no control over those costs. The public and medical profession have been exploited, and professionals have been caught in the middle, scrapping for fair pay and pushed into the background on policy. We need more exposé like this.
