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Peachfart posted:Removing for profit insurance is only part of decreasing costs. You will have to lower doctor and healthcare salaries for universal health insurance to ultimately work. In certain areas, sure (such as focused speciality areas), and it is something that has to be addressed. But there's a lot of naïveté if people think that every single doctor and person in healthcare is making $500,000 a year and driving around in Ferraris. Costs related to other areas, such as operating room fees, hospital stay fees, ambulance travel, etc., those are some of the significant areas also of cost that need to be revisited. The problem is that at the moment, health care providers/hospitals/etc. use those costs to help subsidize the losses they'd otherwise take when John. Iz. Libertarian decides he would rather pay the tax penalty for not having insurance and goes without anything, only to end up having some significant medical expense occur that he can't afford and doesn't pay. And insurance companies know that they try to increase costs in areas to subsidize those losses, so that's why the negotiated rate ends up being so much lower than the billed rate, and why we need universal healthcare coverage to help. There's other costs too that people don't always think about - my wife pays quite a lot every few years to renew her DEA licensure. Before she worked at a hospital, she also had to pay a significant amount every year for insurance to cover liability and malpractice to protect us in case she missed something and someone sued her for millions of dollars. The hospital now pays for that coverage for her, but of course they are going to look to recoup that cost... which is why tort reform discussion was so common amongst medical staff in the 1990s. But a lot of medical professionals don't make anywhere near what you probably imagine. Medical assistants often start out at minimum wage, and even one she works with only makes about $15/hour now after having been in the field for 10+ years (and my wife just corrected me that she just got bumped up higher). The administrative staff also do not earn nearly as much as some might expect. It's funny but depressing to think about, because I work for a large engineering firm where our receptionist is making nearly $30/hour (and when working on projects, gets billed at nearly $100/hour) and complains about the relatively simple work she has to do, whereas the medical assistant my wife works with has far greater responsibilities but yet makes nearly half. And yet people point their fingers at healthcare as the big problem when there are a lot of other areas of the professional workforce that could also be addressed. Canned Sunshine fucked around with this message at 21:26 on May 7, 2017 |
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May 7, 2017 21:18
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Reminder that Tom Price ran a luxury orthopedic clinic in a rich suburb and when he was on the board of Grady in Atlanta he tried to close it.
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May 7, 2017 21:22
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Peachfart posted:Removing for profit insurance is only part of decreasing costs. You will have to lower doctor and healthcare salaries for universal health insurance to ultimately work. To do that, you'd need to lower tuition fees at universities. No-ones gonna go $400k in debt for a $75k salary. Specifically not clever doctor folks. There's other stuff they could do.
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May 8, 2017 01:25
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VitalSigns posted:You're thinking of horrible rear end in a top hat Bill Kristol I guess he got lucky because they didn't pass a successful healthcare bill.
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May 8, 2017 01:40
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BarbarianElephant posted:To do that, you'd need to lower tuition fees at universities. No-ones gonna go $400k in debt for a $75k salary. Specifically not clever doctor folks. There's other stuff they could do. Law school demonstrates this isn't true at all. Also you can pay doctors six figgies still in a single payer system. Specialists are gonna see a cut in pay more than anything else.
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May 8, 2017 02:08
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Mr. Nice! posted:Law school demonstrates this isn't true at all. Maybe that would inspire more Med Students to become GPs.
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May 8, 2017 02:12
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Specialists with a fair amount of experience can also make a ton of money consulting for pharmaceutical companies. MDs can be pretty highly valued depending on the company.
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May 8, 2017 02:15
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BarbarianElephant posted:To do that, you'd need to lower tuition fees at universities. No-ones gonna go $400k in debt for a $75k salary. Specifically not clever doctor folks. There's other stuff they could do. gently caress this, break up the cartel.
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May 8, 2017 02:16
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The bottom line is, doctor pay and doctor liability aren't the real issues and are boogeymen used to distract people from the real problem. Insurance companies are making billions off of people's lives and it costs our society 3x the rest of the world to cover it. Cut them out, pay doctors medicaid rates for everything, and on the whole our healthcare costs will plummet without really impacting doctors too negatively if at all.
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May 8, 2017 02:17
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FizFashizzle posted:Reminder that Tom Price ran a luxury orthopedic clinic in a rich suburb and when he was on the board of Grady in Atlanta he tried to close it. I don't follow. He tried to close his own clinic?
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May 8, 2017 02:36
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Mr. Nice! posted:The bottom line is, doctor pay and doctor liability aren't the real issues and are boogeymen used to distract people from the real problem. Insurance companies are making billions off of people's lives and it costs our society 3x the rest of the world to cover it. Cut them out, pay doctors medicaid rates for everything, and on the whole our healthcare costs will plummet without really impacting doctors too negatively if at all. Cutting doctor pay by 50% or even 25% would probably be a greater cost savings than forcing health insurance companies to run at cost. I don't think that you can attribute your 3x number mostly to them. Hospitals and pharmaceutical companies are way more profitable than health insurance companies. silence_kit fucked around with this message at 02:47 on May 8, 2017 |
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May 8, 2017 02:42
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Mr. Nice! posted:The bottom line is, doctor pay and doctor liability aren't the real issues and are boogeymen used to distract people from the real problem. Insurance companies are making billions off of people's lives and it costs our society 3x the rest of the world to cover it. Cut them out, pay doctors medicaid rates for everything, and on the whole our healthcare costs will plummet without really impacting doctors too negatively if at all. Exactly this. silence_kit posted:Cutting doctor pay by 50% or even 25% would probably be a greater cost savings than forcing health insurance companies to run at cost. I don't think that you can attribute your 3x number mostly to them. (Edited in:) Hospitals and pharmaceutical companies are way more profitable than health insurance companies. Cutting out health insurance companies entirely is the point. There's so much overhead that they entail that even if they ran at-cost, that's still a cost that has to be made up somewhere. Cost (overall) = (Staff Pay) + (Hospital Various Fees) + (Material Costs) + (Insurance Company Costs/Fees/Markup). Yeah, you can look into adjusting the first three, but why not eliminate the fourth? Hospitals and medical offices already have staff that spend a lot of time coordinating with insurance companies on payment/etc., and that time could could easily be spent instead doing most of what the insurance companies do. Medical insurance companies essentially exist because "Why not, capitalism!" And saying that hospitals are "far more profitable" than insurance companies is laughably obtuse. For-profit hospitals, sure, but they're a bigger part of the problem than most hospitals. Most of your non-for-profit hospitals use their "profit" to expand services, bank some for lawsuits when they occur, carry out research in various fields that get reported to other hospitals, etc. A lot of your medical research doesn't soley come out of universities, but rather hospitals and medical practices. A lot of pharmaceutical companies do reap in massive profits and that is an area of potential reform, since it's all tied to recouping development and research costs while making as much money as possible before the patent expires. It's understandable but not ideal for an affordable health care system, but, once again, "Why not, capitalism!". Canned Sunshine fucked around with this message at 02:54 on May 8, 2017 |
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May 8, 2017 02:49
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It's really starting to piss me off the assholes who voted for this bill are using the line "no ones ever died because they didn't have access to health insurance." I had a friend who grew up very poor, never had health insurance and had a genetic kidney disorder that he couldn't pay to have checked multiple times a year. He developed cancer and by the time he had to go to the hospital it was too late and he died in his early 30's. If he would have been able to pay for his appointments the doctor is certain they would have caught it early and would have had a great chance of surviving. What I'm trying to say is gently caress those assholes I hope they all die a horrible fiery death.
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May 8, 2017 02:50
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Rad Valtar posted:It's really starting to piss me off the assholes who voted for this bill are using the line "no ones ever died because they didn't have access to health insurance." I had a friend who grew up very poor, never had health insurance and had a genetic kidney disorder that he couldn't pay to have checked multiple times a year. He developed cancer and by the time he had to go to the hospital it was too late and he died in his early 30's. If he would have been able to pay for his appointments the doctor is certain they would have caught it early and would have had a great chance of surviving. Yeah; a friend of mine had a bit of a ranting meltdown of that same thing. His mom had to choose between buying food and school supplies and whatnot for two kids or getting her cancer screenings. She chose the former and died when my friend was 18.
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May 8, 2017 02:59
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SourKraut posted:Exactly this. Private health insurance(while bad) is not adding enough cost to the system to simply nationalize it and solve all health care cost issues. It feels good to believe that, but the numbers just aren't there. You need to kill the insurance companies along with cutting provider pay, reducing hospital profitability(or making it non profit), and ultimately reducing coverage to what most single payer countries actually cover(its less than you think).
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May 8, 2017 03:20
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RandomPauI posted:I don't follow. He tried to close his own clinic? Grady is a large hospital right in the middle of downtown Atlanta. Trying to close it is a transparent "gently caress you" to poor black people.
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May 8, 2017 03:25
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silence_kit posted:Cutting doctor pay by 50% or even 25% would probably be a greater cost savings than forcing health insurance companies to run at cost. I don't think that you can attribute your 3x number mostly to them. Hospitals and pharmaceutical companies are way more profitable than health insurance companies. Paying out medicaid rates to doctors would entail a reduction in some doctor wages in addition to eliminating the insurance bite of the apple.
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May 8, 2017 03:25
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Rad Valtar posted:What I'm trying to say is gently caress those assholes I hope they all die a horrible fiery death. Their behavior will be rewarded and they will lead easy, beautiful lives. What a system!
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May 8, 2017 03:26
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get this: include med school debt forgiveness incentives in your universal health care bill
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May 8, 2017 03:33
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Mr. Nice! posted:Paying out medicaid rates to doctors would entail a reduction in some doctor wages in addition to eliminating the insurance bite of the apple. Medicaid's reimbursement rate can be as low as half of cost. Medicaid pays way the gently caress below cost, Medicare pays slightly below or at cost. The public ends up paying for these programs both through taxes and by having the cost shifted to them by the provider. SourKraut posted:And saying that hospitals are "far more profitable" than insurance companies is laughably obtuse. For-profit hospitals, sure, but they're a bigger part of the problem than most hospitals. Most of your non-for-profit hospitals use their "profit" to expand services, bank some for lawsuits when they occur, carry out research in various fields that get reported to other hospitals, etc. A lot of your medical research doesn't soley come out of universities, but rather hospitals and medical practices. I think if you look at the profit margins and overhead for Payers and Provider you'll be in for a bit of a surprise.
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May 8, 2017 03:40
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Xae posted:Medicaid's reimbursement rate can be as low as half of cost. So far anything I've had done via VA choice has been paid at medicaid rates. My vasectomy, for example, cost $700. That's the flat medicaid rate they said. They charge $1200-1400 without insurance, they said, and insurance negotiates to near medicaid rates anyways.
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May 8, 2017 03:53
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Xae posted:Medicaid's reimbursement rate can be as low as half of cost. One of the biggest issues with the health care system in the U.S. is that the "costs" are frequently inflated magic bullshit numbers that have absolutely nothing to do with the reality of providing patient care at all and are simply used as starting points for negotiation with insurers / payers.
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May 8, 2017 04:05
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Xae posted:Medicaid's reimbursement rate can be as low as half of cost. Carefully eluded are the insurance careers dedicated to figuring out when denial of coverage to sick people would be most profitable. Someone's gotta write the algorithms to determine when someone's about to get sick and their profile 'could use a once-over,' for, uh, no reason. Killing private health insurance won't fix American health insurance at a stroke, but it will eliminate something whose continued existence at anything like its present power is reliant on the system remaining broken.
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May 8, 2017 04:29
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The government negotiated rates already represent fairly what the actual costs are while still providing quality pay for the doctors.
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May 8, 2017 04:29
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Oneiros posted:One of the biggest issues with the health care system in the U.S. is that the "costs" are frequently inflated magic bullshit numbers that have absolutely nothing to do with the reality of providing patient care at all and are simply used as starting points for negotiation with insurers / payers. Yeah in a system where doctors will accept a percentage of what they would bill to insurance just to have payment in cash and not dick around with insurance seems to indicate there could be a lot of savings by just nuking the insurance companies and having a true socialized program.
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May 8, 2017 04:32
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axeil posted:Yeah in a system where doctors will accept a percentage of what they would bill to insurance just to have payment in cash and not dick around with insurance seems to indicate there could be a lot of savings by just nuking the insurance companies and having a true socialized program. The amount of hospital overhead dedicated to having the paperwork for twenty separate insurance systems payment method for every conceivable DRG code is also one of those gigantic "cost savings available here" signs, and that's before you factor in the dedicated Department of Nuh Uh responsible for contesting claims denied on grounds the hospital did something wrong. Within which, of course, can usually be found the department of maximizing claims convincingly, a profitable line of work for an ambitious hospital system. Going to full on fabrication is a little more hazardous, but everyone's got a dedicated "how do we bill the maximum" team.
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May 8, 2017 05:03
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Mr. Nice! posted:So far anything I've had done via VA choice has been paid at medicaid rates. My vasectomy, for example, cost $700. That's the flat medicaid rate they said. They charge $1200-1400 without insurance, they said, and insurance negotiates to near medicaid rates anyways. Medicaid rates are way below private insurance rates. Take a look at the percentage of providers who stopped accepting Medicaid patients. http://health.usnews.com/health-news/health-insurance/articles/2015/05/26/youve-got-medicaid-why-cant-you-see-the-doctor Mayo Clinic officially set a policy of preferring private payers to public payers, due to their higher rates. http://www.startribune.com/mayo-to-pick-privately-insured-patients-amid-medicaid-pressures/416185134/ Mr. Nice! posted:The government negotiated rates already represent fairly what the actual costs are while still providing quality pay for the doctors. Medicare does not negotiate. Oneiros posted:One of the biggest issues with the health care system in the U.S. is that the "costs" are frequently inflated magic bullshit numbers that have absolutely nothing to do with the reality of providing patient care at all and are simply used as starting points for negotiation with insurers / payers. Sure, providers tend to use the word "cost" and "what we would like to get paid" interchangeably, but there are real measures of cost. axeil posted:Yeah in a system where doctors will accept a percentage of what they would bill to insurance just to have payment in cash and not dick around with insurance seems to indicate there could be a lot of savings by just nuking the insurance companies and having a true socialized program. Medical billing is a huge clusterfuck, not just at a technical level. Providers accept a fraction of billed amount because that is all insurers pay anyway. Private payers are allowed to reduce to the [url=https://en.wikipedia.org/wiki/Usual,_customary_and_reasonable]Usual, Customary and Reasonable/url] amount. If your cash offer is greater to or equal to that amount they'll take it. There is a lovely self-reinforcing cycle where care costs too much for the uninsured so patients can't pay. Private payers use buying power to avoid the cost shifting to them, public payers usually set prices by fiat so they avoid it as well. So the uninsured end up paying for other uninsured. Which means the cost goes up, which means fewer people can afford it. Which means prices for the uninsured go up, etc. The ACA tried to resolve this by making sure everyone had decent coverage. Providers bill for the jacked up amount in the hopes that they run into the random person who can pay it. They don't expect that much though. Xae fucked around with this message at 06:16 on May 8, 2017 |
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May 8, 2017 06:11
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axeil posted:Yeah in a system where doctors will accept a percentage of what they would bill to insurance just to have payment in cash and not dick around with insurance seems to indicate there could be a lot of savings by just nuking the insurance companies and having a true socialized program. The true socialized program is still going to have an insurance-like beuracracy.
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May 8, 2017 13:42
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Xae posted:
The amount of essentially legalized fraud from the medical establishment shouldn't be forgotton. Once my wife went to a medical center for a short, prescheduled, non emergency breathing test. She got billed $3000 for this.
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May 8, 2017 14:02
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RandomPauI posted:I don't follow. He tried to close his own clinic? tom Price started a very successful ortho clinic a rich atlanta suburb. On the spectrum of medicine, what he did was just short of a beverly hills plastic surgery practice as far as urgent medicine goes. Of course there are major needs for orthopedic medicine and I'm oversimplifying, but most of his patients were people that were hoping a rotator cuff surgery could take some strokes off their golf game. Guy never dealt with medicaid, and every person that qualified for medicare could also pay out of pocket. He was just printing money. Eventually he managed to work his way onto the board at Grady for political reasons. Grady is a major trauma hospital right smack dab in the middle of downtown atlanta that treats a very under served community. It has every problem you'd expect from a hospital that primarily deals with medicaid, people without it, and oh every gunshot wound in atlanta. also whomever just walks in off the street needing narcan. It's also the best place in the south east if you're having a stroke. Now he did part of his residency at Grady as well. Every single physician in the greater Atlanta story have a Grady story. Once he was on the board and well on his way to republican stardom, he went out of his way to close the drat place because it couldn't turn a profit. I don't know and can't find if he was there in 2007 when they drat near pulled it off, but it was a priority for him. A lot of this is memory from Atlanta stories written at the time so I can't find them all too well. anyway closing grady then would have forced basically all of south atlanta to go to atlanta medical center which is a kiss of death. He's a piece of poo poo.
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May 8, 2017 14:17
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evilweasel posted:The true socialized program is still going to have an insurance-like beuracracy. This beuracracy[sic] already exists. Of course there will be additional overhead adding people to it, but it isn't near what the current insurance overhead costs us now. Xae posted:Medicaid rates are way below private insurance rates. They refuse to accept medicaid because of greed not because the payout is too low. And I didn't mean that they actively negotiated and using the word negotiate was incorrect. I meant the fixed government price that has already been tabulated.
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May 8, 2017 15:05
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Mr. Nice! posted:This beuracracy[sic] already exists. Of course there will be additional overhead adding people to it, but it isn't near what the current insurance overhead costs us now. Mayo acceps Medicaid from Florida, Minnesota, North Dakota, South Dakota and Wisconsin. http://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance/medicaid
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May 8, 2017 15:14
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Medicaid rates are frequently far too low. They're set by the individual states, so they're subject to political pressure, and due to various technical decisions it is extremely difficult to sue to get them increased (functionally no one has standing, basically).
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May 8, 2017 15:14
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Mr. Nice! posted:This beuracracy[sic] already exists. Of course there will be additional overhead adding people to it, but it isn't near what the current insurance overhead costs us now. The overhead on Medicare being lower than private insurance is debatable. If you measure it as percent of payments it is lower, if you measure it per member it is higher. Naturally the "correct" method is whichever backs your ideology. You realize that providers can costs that aren't their own salaries, right? "Negotiate" and "dictate" are not interchangeable terms.
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May 8, 2017 15:21
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Mr. Nice! posted:This beuracracy[sic] already exists. Of course there will be additional overhead adding people to it, but it isn't near what the current insurance overhead costs us now. Not relevant to what was being discussed: that doctors will take less, in cash, not to need to deal with insurance bureaucracy. Mr. Nice! posted:Law school demonstrates this isn't true at all. This is a dumb argument as well, not least because people don't go to law school to get a $75k job because such jobs largely don't exist. Law schools aren't a good way to look at how to handle medical schools for a lot of reasons, such as (a) the current state of law schools is real bad (b) it's real bad in part because all you need for a law school is a classroom and a professor so they're easy moneymakers, while the same is not true of medical schools. evilweasel fucked around with this message at 15:45 on May 8, 2017 |
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May 8, 2017 15:37
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Rad Valtar posted:It's really starting to piss me off the assholes who voted for this bill are using the line "no ones ever died because they didn't have access to health insurance." I had a friend who grew up very poor, never had health insurance and had a genetic kidney disorder that he couldn't pay to have checked multiple times a year. He developed cancer and by the time he had to go to the hospital it was too late and he died in his early 30's. If he would have been able to pay for his appointments the doctor is certain they would have caught it early and would have had a great chance of surviving. It bugs me the most because it is so easily disproven and I'm getting annoyed at the news for not pointing that out. All the morning shows just went with 'isn't this a dumb thing to say' instead of pulling up the 2009 statistic showing that 45,000 people die annually from lack of ability to pay for medical care (insurance).
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May 8, 2017 16:04
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Caros posted:It bugs me the most because it is so easily disproven and I'm getting annoyed at the news for not pointing that out. All the morning shows just went with 'isn't this a dumb thing to say' instead of pulling up the 2009 statistic showing that 45,000 people die annually from lack of ability to pay for medical care (insurance). Statistics don't really have a meaningful impact on people. I'd rather the news stories be telling stories like Rad Valtar's because they bring home exactly why it's such a monstrous thing to say and why it's so false. Statistics are easy to ignore.
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May 8, 2017 16:07
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WV was basically decomposing because they didn't have access to anything.
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May 8, 2017 16:08
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Also just in general anyone who thinks they have a simple solution to an enormously complex system is, well, dumb. A lot of dumb people think medical costs are all just certain Bad People and we just need to punish those Bad People. There's a lot of points in our system where the incentives are simply not good ones to make the system more efficient and we need to work on those. The way we pay for drugs incentives research poorly, because what drugs will be most profitable to hold a patent on is not the same as what drugs produce the greatest benefit to society - for example, the difference between a one-time vaccine vs. a drug that manages symptoms. Our healthcare system does a bad job at getting people sufficient preventative care (in no small part because lots of them are uninsured or underinsured). One of the lesser-noticed parts of Obamacare was reforming the incentives to push down the cost of care by incentivizing the right things and removing incentives that we don't want. There is also a tremendous amount of money spent on end-of-life care. This is a really difficult subject that I don't have any clue how to handle but the reality is that is where a huge amount of medical spending goes - the last two years of life. And it's not clear how much of this does anything - either in lengthening life or making quality of life better - and even stuff that pretty clearly doesn't do either or makes things worse people want because they want that chance at Not Dying. Which, all in all, is a rather reasonable belief, when I'm old I'm sure not going to be interested in dying either. It is pretty clear, beyond dispute really, that UHC does better on virtually all metrics than our current system. But a lot of the reasons aren't Punishing Those Greedy [xxx]. There's no reason to make doctors into the enemy - virtually every doctor I know below 45 is fully in favor of UHC because they see the people who are sick, uninsured, that they can't treat as well as they should etc. every day. Any good UHC system is still going to pay doctors very well: it is one of those professions that should be paid well. We want our best and brightest as doctors, not hedge fund managers, etc. The waste in the system isn't doctor pay, and it really doesn't take much analysis to realize that. edit: also there are few people who loathe insurance companies more than doctors do. evilweasel fucked around with this message at 16:12 on May 8, 2017 |
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May 8, 2017 16:09
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Caros posted:It bugs me the most because it is so easily disproven and I'm getting annoyed at the news for not pointing that out. All the morning shows just went with 'isn't this a dumb thing to say' instead of pulling up the 2009 statistic showing that 45,000 people die annually from lack of ability to pay for medical care (insurance). This is the problem with intelligent people having problems communicating with dumb people. They assume that everyone knows it's not true and that it would be patronizing to say so. Clinton did this a lot. Trump patronizes the gently caress out of his supporters, but paradoxically they feel *respected* because they understood what he said, instead of feeling that the whole thing is a private joke that they aren't quite in on.
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May 8, 2017 16:09
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