patrick.net

The best way to lower health costs is to:

1. Take profit out of the equation

2. Control salaries for doctors (specialists make substantially more in the US than in other industrialized countries)

3. Control prescription drug costs through importation and negotiaton

4. Fine hospitals that encourage non-critical patients to use the ER. There was an article in the Huffington Post yeasterday about hospitals ADVERTISING their ERs on billboards.

FortWayne says

If any of you show up at a hospital, in most cases, you'll get about 10+ bills from different departments inside, different doctors and they'll never give you an estimate prior to care even.

Yep, this is more or less how it works. Very few medical providers will give quotes on costs for procedures, but in my experience this for out-of-plan providers, and there is no way to compare cost with in-plan providers because the in-plan providers will not give you an estimate.

FortWayne says

The way medicare pays, it makes costs higher due to subsidy.

That is not the way medicare works. Medicare sets their own rates and is often 20-30% cheaper than private care.
http://www.cbo.gov/ftpdocs/99xx/doc9924/Chapter5.9.1.shtml
Scroll down to the section on "Comparison of Public and Private Payment Rates "

FortWayne says

And it also makes doctors not go into Family practices because very little is paid there.

So, you are saying that this is medicare's fault? There are many factors that are contributing to this problem in US medical care, medicare is not one of them.

FortWayne says

There are a lot of things that need to be addressed. But government isn't a solution. Competition creates innovation, lower prices, etc...

Kind of like how removal of government intervention, and encouraging competition has created innovation and lower prices in industries such as: fire services, police services, roadways, etc.

There are some industries where free market practices work great, and even then you need government regulation to ensure that competition continues and monopolies don't arise.

Other industries don't work well in a free market and if left to the private sector can stifle the greater economy. Could you imagine the effect to commerce if every time you pulled out of your driveway you had to pay a toll, or even a toll to use the sidewalk?

I agree with Patrick's claim that nationalizing health care would be a good thing for small business, and the over all economy.

Tenouncetrout says

Teach someone a proverb, and he'll use it out of context to make an unrelated point.

Tenouncetrout says

We need a health care system in this Country that our taxes pays for, even if it cost us more in the long run. A system that isn't a "Hey you used more than ME!!!!" argument. Sounds like a bunch of greedy two year olds, fighting over icecreme.

Anything that looks like Insurance will STINK like insurance stop kidding our selves.

We need people making comments to have the ability to know whether anyone other than themselves can decode what they are saying. Does the term self involved mean anything to you?

Or maybe it's just the weed.

Does medicare look like insurance? Somehow they handle a huge part of all the really big stuff, you know, those pesky little health issues that come up in old age.

I love how govt. de-regulation created innovation on Wall St. Look at all the wonders that innovatins like derivates, credit default swaps, and mortage backed securities brought. That worked out great. I hope we can replicate that same innovation in healthcare.

HousingWatcher says

I love how govt. de-regulation created innovation on Wall St. Look at all the wonders that innovatins like derivates, credit default swaps, and mortage backed securities brought. That worked out great. I hope we can replicate that same innovation in healthcare.

Yes, health care in this country needs more innovation in how to make it more profitable.

gromitmpl says

Furthermore I do not get where you all think that medical care is so expensive. Sure a heart transplant is expensive. Other things are expensive but many things are not that expensive

The total bill for our last child delivery was over $30K. I'd call that pretty expensive.

I have a geat idea: Let states and Wall St. take out life insurance policies on retired teachers, deny them healthcare so they will die quickly, and then make millions of dollars from the policies.

Oh wait, Rick Perry already thoght of it:

http://www.huffingtonpost.com/2011/08/25/rick-perry-texas-life-insurance-scheme_n_935666.html

Medicare expense growth rates vs. private insurance growth rates:

HousingWatcher says

I have a geat idea: Let states and Wall St. take out life insurance policies on retired teachers, deny them healthcare so they will die quickly, and then make millions of dollars from the policies.

Oh wait, Rick Perry already thoght of it:

http://www.huffingtonpost.com/2011/08/25/rick-perry-texas-life-insurance-scheme_n_935666.html

Come on let's be fair, they never said that they would deny health care. They just stood to profit 100's of millions on the death of retired teachers, and the quicker they died the better for their bank account.

Never be worth more dead than alive.

HousingWatcher says

Medicare expense growth rates vs. private insurance growth rates:

I would be interesting to see the chart 2000-2010.

HousingWatcher says

Oh wait, Rick Perry already thoght of it:

http://www.huffingtonpost.com/2011/08/25/rick-perry-texas-life-insurance-scheme_n_935666.html

Oh, yeah and what did the teachers get out of the deal...

50-100 bucks up front and that warm feeling inside knowing that the state and rich investors need you to die ASAP to get a return on their investment.

leoj707 says

Come on let's be fair, they never said that they would deny health care. They just stood to profit 100's of millions on the death of retired teachers, and the quicker they died the better for their bank account.

I would agree that there must be a little more to this story, not to be in any way defending it, or Perry.

Buying insurance on a pool of old people shouldn't be profitable. That's what actuaries are for, to make sure it's slightly profitable to the insurance companies. Unless they knew for some reason that teachers in retirement have especially lower life expectancy.

As for the idea that they planned on denying health coverage, that's pretty hard to believe. Even if Perry were a total dirt bag, he would have to have the political savvy to know how that could hurt him. Not to mention the fact that it would be a huge crime.

IT was a stupid idea though. Maybe secretly they figured that buying life insurance on old people for other's benefit would cause the insured to die of paranoia.

leoj707 says

Yep, this is more or less how it works. Very few medical providers will give quotes on costs for procedures, but in my experience this for out-of-plan providers, and there is no way to compare cost with in-plan providers because the in-plan providers will not give you an estimate.

This really should be addressed. I do think this is a big contributor to the problem. People don't know what they are paying or will pay.

I once showed up to a doctor, it took almost an hour to get an estimate out of those people.

leoj707 says

That is not the way medicare works. Medicare sets their own rates and is often 20-30% cheaper than private care.
http://www.cbo.gov/ftpdocs/99xx/doc9924/Chapter5.9.1.shtml
Scroll down to the section on "Comparison of Public and Private Payment Rates "

I know they do. But often it costs more than in private sector because of the subsidy. It costs less to the patient because their bill is less, cumulatively it adds to a bigger number.

leoj707 says

So, you are saying that this is medicare's fault? There are many factors that are contributing to this problem in US medical care, medicare is not one of them.

It's how government pays for medical care. It directs how medical field goes. Look if they'll start paying subsidies for you to make IBM computers, all computer tech field will go in that direction for "free" uncle Sams sugar. Thats how our medicine works.

leoj707 says

Kind of like how removal of government intervention, and encouraging competition has created innovation and lower prices in industries such as: fire services, police services, roadways, etc.

Fire services and police services are state, not federal. Freeways which are federally sponsored is a totally different topic, taxpayers paid for commerce when private sector could not do the job yet.

Problems in medical industry need to be addressed though, and not by simple tax more and spend more. That's just wasteful.

bdrasin says

It is true that there are some market inefficiencies caused by having state-level regulation of health insurance (just like any other product which is regulated at the state level) but you are being wildly unrealistic in assuming this is more than a minor factor.

You are being wildly presumptuous in assuming that I believe it is a major factor vs. a minor factor. But I am happy that you do acknowledge it as a factor.

bdrasin says

I don't have a problem in principle with replacing state-level regulation of health care with a nationwide regulatory system, but
1) Its unrealistic to think that the savings will be enough to deal with the scale of the problem, and
2) It will be a long, long difficult process to get all of the states to agree on such a system. And I think this is the point; the republicans who favor this basically want to do nothing.

This is not about replacing a state system with a national system, but even using that assumption: you don't have a problem with it in theory, but you do in practice, because:
1) Even though there might be some savings involved, it is not enough for your liking, and
2) You think it would take too long because of the difficulty getting all the states to agree, although this is completely irrelevant to allowing individuals to purchase plans from wherever they want?

In other words, you are for only major, revolutionary changes, not minor changes even if you agree they may have minor positive impacts. And since Republicans are not for the revolutionary change you want, then their proposal for a minor change - that you acknowledge might be helpful - counts as not wanting to do anything.

Another example of ideology first.

marcus says

Even if Perry were a total dirt bag, he would have to have the political savvy to know how that could hurt him.

Maybe... but he should have had the savvy to know that betting on old people dieing would not looks so good politically.

marcus says

Buying insurance on a pool of old people shouldn't be profitable. That's what actuaries are for, to make sure it's slightly profitable to the insurance companies. Unless they knew for some reason that teachers in retirement have especially lower life expectancy.

Yeah, that was very strange to me. The only way to profit through a life insurance scheme is to know something that the actuaries don't.

Paralithodes says

In other words, you are for only major, revolutionary changes, not minor changes even if you agree they may have minor positive impacts. And since Republicans are not for the revolutionary change you want, then their proposal for a minor change - that you acknowledge might be helpful - counts as not wanting to do anything.

Not really--there are a lot of things that might be helpful. This idea also might be detrimental by segmenting the population and drastically raising rates on older folks, allowing private insurance to cover only the "healthy" folks and pushing the rest onto Medicare.

How about we talk instead about ideas that have already been proven successful in other countries? You know, where healthcare costs are half of what they are here.

leoj707 says

Maybe... but he should have had the savvy to know that betting on old people dieing would not looks so good politically.

My point exactly. That's why I think there is something missing here, in spite of the fact that I don't like Perry at all. Then again, who knows ?

FortWayne says

I once showed up to a doctor, it took almost an hour to get an estimate out of those people.

Wow, that was quick, and was that before getting care? Usually you don't know the cost until you get the bill weeks later.

FortWayne says

But often it costs more than in private sector because of the subsidy. It costs less to the patient because their bill is less, cumulatively it adds to a bigger number.

Yes, it costs less for the patient:
"...on average, Medicare’s payments were about 9 percent below the costs of serving Medicare patients, whereas pri­vate payments were about 30 percent above costs."

But, also the total cost is less for medicare than the private rates:
"Private rates are noticeably higher than Medicare’s rates in areas with less competition among providers... ...the rates paid to physicians by private insurance plans are an average of 30 percent higher than Medicare’s rates in small metro­politan areas and rural areas, 10 percent higher in medium-sized metropolitan areas, and 1 percent higher in large metropolitan areas."

I would be interested to know you source for Medicare costing more than private care.

FortWayne says

Fire services and police services are state, not federal. Freeways which are federally sponsored is a totally different topic, taxpayers paid for commerce when private sector could not do the job yet.

Well, while those are run at the state level there are federal agencies (FBI, etc.) and regulation of those state projects. There is a reason why you can take a fire hose from California, and it plugs right into a fire hydrant in Florida.

Why could medical care not be run the same way?

FortWayne says

Problems in medical industry need to be addressed though, and not by simple tax more and spend more. That's just wasteful.

I agree that we need to cut the waste. That is one of the reasons why I think that universal health care is the way to go. Delivery system aside, we spend over twice as much for health care than other industrialized "modern" nations. For all this extra cash we get worse outcomes than the "cheaper" systems; we have a lower life expectancy and a higher infant mortality to name two undesirable outcomes.

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

Paralithodes says

In other words, you are for only major, revolutionary changes, not minor changes even if you agree they may have minor positive impacts. And since Republicans are not for the revolutionary change you want, then their proposal for a minor change - that you acknowledge might be helpful - counts as not wanting to do anything.

Another example of ideology first.

*sigh* Our system is not working; its too expensive for us to afford (and getting worse) and and its not particularly effective. I'd say lets look at countries which have systems which DO work by this measure (cost and effectiveness) and try to copy what they are doing. This isn't ideology, it isn't revolutionary, its common sense. Follow the evidence, I say.

Again I ask you - what country has a health care system closest to what you think we should have? It sounds like you think a completely unregulated market would be best (i.e. let the states conduct a "race to the bottom" in insurance regulation). What country does this, and how is that working for them? If the answer is "none", then what makes you think this is what will work?

It really astonishes me that you would think that looking around the world for what is working IN PRACTICE and using that as evidence is an "ideology first" approach.

gromitmpl says

Patrick - where are you getting quotes. I find it hard to believe what your saying.

My actual Blue Shield rates:

And it's not due to anything medical in particular. They showed me it's the same outrageous rate hikes for everyone in my age group.

Other quotes were from http://www.healthcare.gov/

leoj707 says

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

Because of American exceptionalism. Obviously if we pay so much more it HAS to be because we get so much more. (kidding).

leoj707 says

That is one of the reasons why I think that universal health care is the way to go.

Everyone with the slightest intelligence knows this to be true, and also knows that it's inevitable that we will have universal health care. But unfortunately we have this money sucking monstrosity in place and a corrupt government beholding to it.

tatupu70 says

The total bill for our last child delivery was over $30K. I'd call that pretty expensive

My assumption is that the 30k was not for the delivery but was for complications arising from or after the delivery.

Also was that from your OB or from some one else.

I know many many many many people who have more than your average number of children and that 30k is more than any one of them have spent for the delivery of all their children combined.

That number is either not for the delivery or because you stayed at the Beverly Hills Wilshire to deliver the baby.

My actual Blue Shield rates:

That is expensive but of course expensive is relative to what your getting. I assume you have a fairly basic plan though since your rates in 06 were fairly low.

Maybe its because you are in California? I just checked a couple weeks ago for my own family and saw several plans in the $3-$400 range that would be fine. More or less these might be considered catastrophic loss type of insurance but in my experience even high deductible plans have hidden beneifts like negotiated rates which help in cases of even more normal medical care.

If you absolutely need it I'd start with high deductible plans and pay for regular care out of pocket. In my experience Doctors love working with people who actually pay cash and give steep discounts (%30- 50%).

Why should Patrick pay for healthcare out of his own pocket? He should go to the ER and let the govt. pay.

marcus says

Everyone with the slightest intelligence knows this to be true, and also knows that it's inevitable that we will have universal health care. But unfortunately we have this money sucking monstrosity in place and a corrupt government beholding to it.

I would like to think that a universal system is inevitable, but with the way things are going I am not going to hold my breath.

gromitmpl says

My assumption is that the 30k was not for the delivery but was for complications arising from or after the delivery.

Haha... hahaha... maybe there were complications, if so they we very minor. I don't remember the exact number, but for my kids the (cesarean) delivery was almost 30k. Then the immediate complications were about 850k. The cost for the first year of life was close to 1M (this was with only one surgery required). They were however twins that each get there own deductible upon birth.

gromitmpl says

That number is either not for the delivery or because you stayed at the Beverly Hills Wilshire to deliver the baby.

Funny thing is that staying in a luxury hotel and hiring a private nurse is cheaper than a hospital stay, but I don't think insurance covers that.

leoj707 says

Wow, that was quick, and was that before getting care? Usually you don't know the cost until you get the bill weeks later.

I was referred to a specialist (his name is Michael J Hollander, a money grabbing bastard). Came in for an exam and xray. It was almost impossible to get the price out of the office staff, their hourly rates, etc...

Nightmare. And that was not the worst case either. Just going to a hospital, one gets to run into tons of staff that show up for under a minute but bill you for an hour of their time.

leoj707 says

I agree that we need to cut the waste. That is one of the reasons why I think that universal health care is the way to go. Delivery system aside, we spend over twice as much for health care than other industrialized "modern" nations. For all this extra cash we get worse outcomes than the "cheaper" systems; we have a lower life expectancy and a higher infant mortality to name two undesirable outcomes.

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

I don't have a solution either. But I really do not trust our government to do it. Their track record of selling out to special interests is very consistent.

gromitmpl says

My assumption is that the 30k was not for the delivery but was for complications arising from or after the delivery.
Also was that from your OB or from some one else.

It was a C-section. No complications. That was the cumulative cost for everything.

Just the local hospital with nothing special--no extra stay or special room or anything...

FortWayne says

I was referred to a specialist (his name is Michael J Hollander, a money grabbing bastard). Came in for an exam and xray. It was almost impossible to get the price out of the office staff, their hourly rates, etc...

Yeah, what a nightmare.

I have gotten the run around between insurance the hospital where the only answer I could get after several hours on the phone was, "The prices are confidential."

FortWayne says

leoj707 says

...
...

Why, as a nation are we wasting so much money on a health care industry that gives us shitty returns? Why don't we "shop around" and find out how other countries provide better care for half the price?

I don't have a solution either. But I really do not trust our government to do it. Their track record of selling out to special interests is very consistent.

What? He just told you a solution, and you say you don't have a solution "either"!

In a way this is refreshingly honest, you saying that no evidence will ever convince you that a "government-based" solution is the way to go. You are just shrugging off the example of all of the other countries. Why is it that they can do it but we could not make it work by doing what they are doing? Is there some sort of american-exceptionalism-in-reverse going on here?

The underclass does not need healthcare or education. They just need to breed faster.

If only there was a candidate who opposed healthcare, education, and demonstrated support for teen pregnancy. He would be my man.

tatupu70 says

It was a C-section. No complications. That was the cumulative cost for everything.

Tat - this is why my wife and I are leaving the country soon. We can't afford to have children, as our medical insurance sucks balls, even if there are no complications.

Or rather, we can afford to have a child - if we give up most or all of our savings so far ($15k), which we want to use to start a business and have as a reserve.

leoj707 says

I would like to think that a universal system is inevitable, but with the way things are going I am not going to hold my breath.

I didn't say soon. For all I know the pendulum swings all the way to fascism, and it takes many decades or even hundreds or thousands of years for us (humans and specifically the U.S.) to get their act together.

Still, it is inevitable.

Moneyworth's Financial Advice #573:

If you desire a child to give your nanny something to do, consider adopting a Bohunk from Tsarist Russia. They are the lightest of the Colored races and can subsist on a diet of hearty potato alcohols. Good in science and appreciates stern and unyeilding fathers.

Your wife may want an Oriental doll from Peking China. While they are the most industrious of the Colored races, it can be difficult acquiring fish and rice while your family is traveling, and you do not want your almond eyed baby to starve. Plus what ultimate purpose does a female serve?

Adopting is much preferred to losing your trophy wife's vagina to the devastation of childbirth. Good luck!

FortWayne says

Just look at Obamacare. Insurance rates skyrocketed with it.

Liar. Anything that would increase rates hasn't gone into effect yet.

Insurance rate went up because the economy sucks. This is how insurance works -- when times are good, the insurance company can invest the premiums and get good returns. When the economy tanks, they don't get sufficient returns, and actuarial math says they need higher premiums. Obamacare hasn't caused rates to go up yet, regardless of whether it ultimately might do so (a dubious claim based on current projections).

FortWayne says

You'd be surprise how much stupidity you'll run into. People stop by for headaches, sneezing, aches, etc... And most get sent back often with prescription for tylenol at most.

Prove that it's the case. There are many many many studies done on ER usage. Find me one that says a substantial number of people go to ERs for headaches or the common cold and are sent back with tylenol. This should be easy to prove, right?

Reality says

The reporting of infant mortality (government statstics issue; in Cuba, a person is not officially born until he/she is 10 months old, as a way of keeping infant mortality statistics down)

This should be easy to prove right?

http://www.google.com/search?hl=en&q=cuba+birth+statistics+%2210+months%22

Nothing. Hmm. Am I doing a bad search? What's your source? This should be easy to find, right?

Reality says

Which is why the decision should be left to the individual instead in the hands of monopolistic bureaucrats. Do you honestly think a monopolistic bureaucrat would refrain from spending $1M of your money to get a 20% chance of extending the life of his mother or his son for 1 day at your expense?

Why can't it be? If it's part of basic coverage and the government plan covers it, then it covers it. If not, the individual has to pay for it (as you suggest). How is the government making a death decision (a la "death panels")? I'm not sure what you're asking -- either the care fits within plan standards or it doesn't.

The government is guaranteeing a basic standard of healthcare for a particular price. If you want something outside of that standard, you pay, just like you are suggesting. There is no "death panel" decision involved. Only ideologues suggest this crap as if it's an analytical complication.

Reality says

The life expectancy issue is a red herring. That of the US is weighed down by recent immigrants and poor families that have theoretical access to free health-care but do not or can not actually use them, especially in pre-natal care. That leads to higher infant mortality among particular groups. Infant mortality is the biggest factor in "average life expectation," not longevity of the elderly per se.

If what you're saying is true, then California should have the highest infant mortality rate because it has the highest number of immigrants, right? New York should be second highest? Maybe Florida should be third highest?

FAIL: http://en.wikipedia.org/wiki/Infant_mortality#United_States

When we're saying "recent immigrants," we're talking about Mexicans right? That means Latinos should have a higher infant mortality than whites according to your premise:

FAIL, again: http://www.statehealthfacts.org/profileind.jsp?ind=48&rgn=1&cat=2

In addition, you're suggesting that poor people willfully don't get prenatal care even though it's available to them and that's what raises infant mortality. If so, that means that, poor blacks who do get prenatal care in the first trimester should have the same infant mortality rate as whites who get prenatal care in the first trimester right?

FAIL, striiiike 3, you're out: http://www.arc.org/racewire/030210z_kashef.html

But thanks for playing our game and giving us talking points that aren't true.

@corntrollo

>very sane plan involves rationing. There are cost-benefit analyses that must be made in all plans. It is not cost effective to spend $1M to give a 20% chance of extending someone's life 1 day.

Agreed. By nature any service or product that is limited is "rationed" in some way. That's what most Americans don't get.

tatupu70 says

It was a C-section. No complications. That was the cumulative cost for everything.

Just the local hospital with nothing special--no extra stay or special room or anything

Ok wait a second though. Your saying this was a scheduled C-section?

Also when you say the "cost" was 30k are you actually out of pocket for or on the line for 30k or is your insurance company paying?

Hospitals play games with insurance companies so while they may put 30k down as they bill they have a negotiated rate with the Insurance company - or will so what we should be talking about is not the numbers on some piece of BS paper but what your insurance company actually paid.

In anycase 30k sounds about double what the normal putative cost of a c-section is, at least in these parts, and ultimately I think most insurance companies pay far less than that.

bdrasin says

For example, Blue Cross of Texas sells health insurance in California (I know this because a company which recruited me here in CA used them for coverage).

Odd... When I visited the BCBS Texas site this morning to get a quote, it kept telling me to enter a valid zip code for Texas! Perhaps CA allows some type of exception for corporate purchases vs. individual purchases? If so, why the rule, and why the exception?

bdrasin says

It sounds like you think a completely unregulated market would be best (i.e. let the states conduct a "race to the bottom" in insurance regulation). What country does this, and how is that working for them? If the answer is "none", then what makes you think this is what will work?
It really astonishes me that you would think that looking around the world for what is working IN PRACTICE and using that as evidence is an "ideology first" approach.

I never once said anything about a "completely unregulated market." Nor did I say anything about looking or not looking around the world. I addressed one small component of something that could be done right now, even if it had just a minor positive effect. However, the fact that you must attribute multiple arguments to me that I did not make at all, is unfortunately not astonishing on this site.

Meanwhile, isn't CA itself similar in population and economy size (or bigger) to many of the countries you would compare for health care? What is preventing the implementation of a state wide program similar to one of the western european countries? You have the perfect place for a proof of concept for the US.