patrick.net

OO: "A neighbor of mine broke her arm in the kitchen, got sent to the hospital right away by ambulance and stayed in rehab for over a month. The total bill was decidedly over $100K." Are you certain that a broken arm was her only injury? Reason why I'm asking is that normally in a broken arm situation there's no ambulance involved unless the person has no reasonable way of getting to the hospital or clinic and rehab isn't normally needed. I'm wondering if she is diabetic - or has some autoimmune disorder....there is more to this

No, she is not diabetic, no other diseases. She bragged about how much she cost the medical system to us, saying that even for a healthy senior like her, they treat her like a royal - with our payment of course. She broke her arm while lifting something, so she called 911, hence the ambulance. Who's to determine the value of life? Money is, no money, no life extension, we cannot afford it.

I'd vote for Tina Fey, tho...

OO sez: >>Nowhere else in the world do you have unlimited national health care JUST FOR the dying population. The reason is, of course, that in the US, the entrenched principle is that government gets all the unprofitable enterprises, whereas private industry gets to cherry-pick for profit, all the while getting to brag about how they are more efficient and all that. Privatize profits, socialize loss. Does it sound familiar?

Tenpoundbass says

Communism is the government owning your house as well… = America has that now (Check) TARP anyone Communism is owning the banks = check

No, communism would be that nobody owns the house and nobody owns the banks (or everyone owns the house and everyone owns the banks). What you're describing is socialism, though that isn't what America has now either. The only thing that the government owns is GM, some parks, some highways, a few buildings, the post office, and a bunch of debt.

Current government policies are ensuring that only cash investors can buy houses. This means MORE renter, not fewer.

Not with an FHA loan!

Anyone who wants to be President who doesn't even understand what the vice president does is not fit for either job, period. Unless your goal is the final destruction of America, you'd be a fool for supporting her.

Tenpoundbass says

elliemae says

Our desire to have national healthcare coverage is genuine. It is necessary. People here are bitching alot, but little Jessica and countless others will stop receiving treatment when their money is gone. It’s possible that they could recover and become tax-paying, productive citizens. And if they never do, they’re still someone’s daughter or sister or wife.

You’re so cool… Like a lil Jewish barnyard Madonna.

You mean an old chick who looks horrible without makeup, lives a Michael Jackson-like life buying up foreign babies, dressing up outrageously and being - well, wierd? Or the one who believes that the story of the $100,000 broken arm is the "billed" charges, not the actual charges? Because Medicare pays approx $1,000 per day maximum for hospitalization, plus 80% of MD charges and labs and xrays... and the rehab, if indeed the arm was the only thing wrong (except that the woman probably fell in her kitchen so she probably would benefit from a bit of physical therapy); less than $400 per day for the first 20 days and afterward the patient pays $133.50 out of pocket... So you're looking at a bill of around $10,000 - $15,000. Which, if the arm was damaged, isn't bad at all. She'll return home, have quality without loss of function and not need supporting social services to keep her in her home, at least for awhile. And, the ambulance bill was probably around $1,500 in the most expensive area, only Medicare will pay about $250. Since all providers accept assignment (meaning that they accept Medicare's approved amount as payment in full), the patient only had to pay approved co-pays & deductibles. Billed charges are the ones on the bills that people receive from theiving, for-profit (even if they say they're non-profit they charge the same) providers. That isn't the amount that's paid. I've seen $300,000 ICU bills paid dropped to 10% or less. So when someone brags that they cost the system a huge amount, they're probably full of shit. Who was it that said "the plural of anecdote is not data?"

Tenpoundbass says

I’d vote for you.

I think that there's a requirement that the VP wears shoes. And I'd have to live on a navy base - my middle-aged heart wouldn't last watching all those hot little recruits in tight naval uniforms... I need a moment... Do they allow goats/chickens/horses/dogs/cats on naval bases? All of these things can be resolved, I guess. After all, as President of the US Senate I could "get in there with the Senators and make a lot of good policy changes that will make life better..." - so I'd assign each Senator barnyard cleanup and repair duty. It'd probably be the first time that they ever got their hands dirty, other when when they were wiggling those silver spoons that's so far up their asses.

elliemae says

Look, guys. We have real problems with healthcare in this country. Sure, we have people who are old who are receiving expensive treatments, even though they’re toward the end of their lives. But who is it that determines the value of a life? If you are 80 years old, you might very well have another 20 years on you. Is your life less valuable than that of a 25 year old? How about if you are an 80 year old Albert Einstein and the 25 year old is a gang-banger from the ‘hood? What if you are 60 and newly married vs a woman of child-bearing age who is single? Single young man vs married older man with family to support? Business owner/taxpayer vs. young person starting out? Whose life is more valuable? We get caught in the minutiae. No system will be perfect. But ours is far, far, far from perfect. Healthcare decisions are made by people who never see the patient and are based on finances alone. If a physician recommends treatment, and another agrees, an insurance company still easily denies payment for the procedure which might save a life or make the life more bearable. Currently Medicare rates set the payment system; insurance companies mirror them to a great extent. But private insurance looks for every reason to deny benefits, from unknown pre-existing conditions to a case manager denying coverage without being knowledgeable about the condition. Medicaid, with current cutbacks, is not covering many extra programs for healthy kids, meaning that when they’re older they may be sick as hell and Medicare will have to cover it. Our desire to have national healthcare coverage is genuine. It is necessary. People here are bitching alot, but little Jessica and countless others will stop receiving treatment when their money is gone. It’s possible that they could recover and become tax-paying, productive citizens. And if they never do, they’re still someone’s daughter or sister or wife. They need action.

I think this argument is really about the fact that every American needs to have health care coverage, which I believe that all parties - liberal, conservative, etc. - agree to. The issue is around who should run the system to provide the coverage (and who will pay for it). I don't believe that the government can run the insurance industry more effectively than private companies competing. Yes, you will have greed and corruption and some issues with payors not covering what they should .... but were comparing this to the government! Just because the government runs something doesn't end all corruption. In fact many issues occur in our current Medicare/Medicaid system because of such issues, and corruption of course is seen all across the government (ever been to Chicago). The other thing that scares me about the government controlling the insurance industry is that decisions around what drugs and devices are covered becomes highly political. Want your hospital in the suburbs of Ohio to get the latest MRI machines, well you need to go lobby your local representative. A company wants a new device covered, well maybe they will run a PR campaign to influence the government and force them to cover something.

I feel that the goverment should stay out of medicine. I think they started most of the current problems by allowing the over regulating of what doctors can do and charge. Because of over regulation it is almost imposable to see a regular doctor for a non-emergency that needs medical attention unless you are willing to wait a long time. This is creating a lot of unneeded expenses. Case in point My wife stubbed her finger on a rusty nail when we were moving. No doctor in the area had time to see her to give her a Tetanus shot. The doctors office recommended for us go to the emergency room if we wanted to get a shot. Because we were put in the position of having to go to the emergency room, what would have been a $200 so bill ended up being almost $2000. Most of those costs being administrative or junk fees from the hospital. The system is screwed up, but I think the problem is over regulation and the exuberant power of insurance companies to regulate prices. I do not think giving the government more power is the fix. I feel that the system was working much better when there was free market, cheaper to. Also, what next should we hand over dentist, eye care specialists and other specialties to government control? I personally do not want the government to have any involvement in determining what doctors I see, how much I pay and how I should be treated.

d3, >>I think the problem is over regulation A tetanus shot ended up costing you $2000, and you think the problem is OVER-regulation? I just don't get the logic behind this type of thinking.

The problem is that over regulation as scared of family practitioners. If you want to get a shot you are forced to go to an emerancy room which costs both them and you more money.

d3, still not getting it. Exactly what kind of regulation is it that "scares off" family practitioners, and how? Why are they seemingly less scared of becoming highly-paid specialists?

I also beleive over regulation would make regular doctor visits cheaper because doctors are currently forced to give a people with insurance huge discounts in there rates. It also costs doctors an arm and a leg for all of the personal and software required to deal with medical billing of insurance providoers. In order to make up the costs docters are forced to raise prices on every one else. If doctors had more power vs the goverment there would be compitition again. Doctors would only be able to charge based on there expenses and what people would be willing to pay them. Also being a good doctor is no longer rewarding because there is no monitary benifit any more. Keeping the goverment out and letting free market in could fix this. If the goverment wants to be involved; I think it should be limited only to subsidizing the costs for low income and for expensive emergancy proceedures.

Some Guy says

Does it not mean that the government controls the means of production?

No, it means that *EVERYBODY* owns the means of production. Socialism is when the government owns the means of production.

Some Guy says

d3 says

The problem is that over regulation as scared of family practitioners. If you want to get a shot you are forced to go to an emerancy room which costs both them and you more money.

Huh? What does government regulation have to do with a doctor being too busy to see you?

The relationship is fairly indirect, but it does exist. From my understanding, for Medicare and a lot of specific treatments ie vaccines, there is price setting that is in effect which prevent a doctor from refusing certain treatments and charging more than a set amount for that treatment. Doctors will often have to take loses to provide certain treatments. Also depending upon the area the doctor serves he may have even greater limits to what he is allowed to charge for certain treatments. This is what has been scaring doctors away.

Some Guy says

You are paying

It is true a doctor maybe charge what he wants, however the insurance and medicare are only obligated to pay a certain amount. For many treatment that amount is set below what makes it profitable for many practitioners to make any money off the treatments. Sometimes they are even forced to take a loss. Why would one spend 8 years in school to be a primary care doctor when you can make more money in most fields with a 4 year education. I just feel that over regulation from medicare and the insurance companies have taken away the profitability of family practice. It is a fact family doctors are leaving the field. I just think that socializing medicine is the current root cause of the problem and adding more regulation will only make things worse

Regarding the $2000 Tetanus shot (even $200 seems high) A good usually quicker and cheaper alternative to emergency rooms for such medical problems are the so called "prompt" and "urgent" care facilities. One of the absurdities of the current system as referenced indirectly in the comments about "billed" costs verses what insurance companies actually pay is that uninsured people are typically charged more by hospitals and other providers and end up paying a higher amount then insured people (either private or Medicare etc.) for the same service. A small step that could help a lot of people without insurance would be a regulation that they be charged on a fee for service basis at a rate no higher then either the Medicare rates or perhaps an average of all the private insurance companies that the provider accepts. The political debate on this proposal would be interesting to observe as I am sure it would be opposed by the entire medical establishment as well as insurance companies but how can this practice be defended?

rdm says

Regarding the $2000 Tetanus shot (even $200 seems high) A good usually quicker and cheaper alternative to emergency rooms for such medical problems are the so called “prompt” and “urgent” care facilities. One of the absurdities of the current system as referenced indirectly in the comments about “billed” costs verses what insurance companies actually pay is that uninsured people are typically charged more by hospitals and other providers and end up paying a higher amount then insured people (either private or Medicare etc.) for the same service. A small step that could help a lot of people without insurance would be a regulation that they be charged on a fee for service basis at a rate no higher then either the Medicare rates or perhaps an average of all the private insurance companies that the provider accepts. The political debate on this proposal would be interesting to observe as I am sure it would be opposed by the entire medical establishment as well as insurance companies but how can this practice be defended?

Sad to say but the urgant care near me was closed about a year ago.. I agree that people without insurance should not be forced to pay more than those with insurance, but I do not think medicare or any other entity should have the excusive right to determine what those fees should be. I do not think the goverment has the ability to fairly regulate prices. A doctor in NYC should not be forced to charge the same as a doctor in Idaho, also if all doctors had to accept the same payment what would be the point of one doctor working harder trying to be better then another. One of the great things about a free market is that you have a choice and if you work harder and make more money you are rewarded by being able to get better things. One of the problems over regulating medicine or any other company is that you end up with rules that may appear fair on paper but are not fair in reality

Where are all the doctors http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/ http://www.law.duke.edu/shell/cite.pl?69+Law+&+Contemp.+Probs.+195+(autumn+2006)+pdf http://bulletin.aarp.org/yourhealth/caregiving/articles/where_have_all_the_doctors_gone_.html

d3, Your argument is essentially that "if doctors could charge everyone whatever they wanted, then prices would go down" mixed in with a bit of "the cost of billing software and services is what makes care expensive now". I'm not buying this argument. Not at all. It defies logic.

TOB, right on. Let us ban rubber bands and electric scooters from medicare. These are the types of items that *would* be cheaper if we had an open an free market.

Where are all the doctors? They have become specialists because they can then charge more. It is as simple as that. It's got nothing to do with medicare, government regulations or anything like that.

Some Guy says

d3 says

Some Guy says

d3 says

The problem is that over regulation as scared of family practitioners. If you want to get a shot you are forced to go to an emerancy room which costs both them and you more money.

Huh? What does government regulation have to do with a doctor being too busy to see you?

The relationship is fairly indirect, but it does exist. From my understanding, for Medicare a lot of specific treatments ie vaccines, there is price setting that is in effect which prevent a doctor from refusing certain treatments and charging more than a set amount for that treatment. Doctors will often have to take loses to provide certain treatments. Also depending upon the area the doctor serves he may have even greater limits to what he is allowed to charge for certain treatments.

I don’t believe that’s true. It may be true that Medicare will only reimburse the doctor for a certain amount, but that doesn’t mean he can’t charge whatever he wants. Unless you are on Medicare, the limiting factor is usually going to be your PRIVATE insurance company. The insurance company decides how much a given procedure is “worth”, and will not pay the doctor more than that amount. Sorry, but you can’t blame the evil government for that. And even then, you still haven’t explained what any of this has to do with a doctor being too busy to see you.

There are a ton of regulations on what a doctor can charge for medicare. The federal government has a cap of 15% over standard allowable rate for a doctor that does not accept assignment (although most do). In addition most states have even tighter regulations on how much a doctor can charge over assignment for medicare. The issue here is around the fact that a doctor couldn't be seen immediately. I know that the local family practice clinic I go to I can always be seen the same day, but they charge me $150 / yr for the privilege of seeing doctors at their practice. Without government interference you can start to see more models like this one. Where the government really needs to step in, is in creating transparency in pricing for medical procedures and visits.

I think Sarah was being facetious with that VP comment. Everyone knows that the veep is second banana but that job doesn't exactly have a bunch of appeal. Some swingers around here seem to consider her the gorilla their dreams and I'm sure they wouldn't mind monkeying with her tail if the time was ripe. Well, at least this Chiquita isn't on the Dole and doesn't act like a fruit.

Cheaper than a lapdance!

It's not just down south: "Northern California home sales highest in three years as prices rise 3 percent" http://www.mercurynews.com/ci_12851341?source=rss For all of the talk about it being impossible to get a mortgage, there seem to be a lot of people buying. Where do they get their money?

camping: "For all of the talk about it being impossible to get a mortgage, there seem to be a lot of people buying. Where do they get their money?" I was told by my investment manager that its hedge funds and REITs buying properties that they intend to resell later for profit. Kind of like "institutional flipping".... Individuals and couples - yes them too. They are buyers who are going for State and Federal incentives ($8k, $20k in Cali if you buy a new home from a builder. Not sure if that program is still going on though). Buyers are using the incentive in lieu of a traditional down that they've saved, so we're heading straight back into the same situation as before where a buyer gets seller assisted financing or some other funny-money arrangement that allows them to bypass time-tested avenues of market entry. Sorry for my simplistic response regarding individual buyers/couple and the "incentive" monies - I read up on this several months ago and seeing the absurdity of it all I've just set it all aside in my mind as junk financing to uncredit-worthy borrowers. However, these are the folk that vote for the politicians that provide this sort of thing. Gov't wouldn't do this unless it worked. Just look at the numbers in Congress who got re-elected. Tells you something, No???

The REITs and hedge funds part makes sense. I'm curious what percentage of the market is them though. As for individuals/couples, assuming we're only talking about non-new homes, only the $8k applies. I believe that also has an income cap of $150k (for couples). In the Bay Area, many of the homes I'm seeing go sale pending are $500k+, so $8k doesn't go very far towards your down and also if they technically can afford a $500k+ house, they should probably be over the income limit anyway. Something doesn't make sense.

"I’m curious what percentage of the market is them though." That I do not know, but what he has told me is that the hedgies and REITs are buying huge blocks of foreclosures directly from lenders, say 1000 residences at a time such as in PHX for example. Prices vary but generally are below 20 cents on the dollar. Some individual investors are doing this too: buying a property at auction for $10k and turning around and selling it for $60k. Sorry, I don't know how many of these form the percentage of RE sales. "also if they technically can afford a $500k+ house, they should probably be over the income limit anyway. Something doesn’t make sense." Yep, another problem to deconstruct.