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evilweasel posted: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. You can do both. Saying that it is dumb without also pointing out that it is a lie isn't great. My only problem with stories like that in a news context is that they give the suggestion that it is anecdotal, not endemic.
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May 8, 2017 16:10
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evilweasel posted: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. This is a really good book about how the incentives in healthcare are totally messed up. Talks a lot about stuff the guy saw at Grady vs. Private Practice and also a whole bunch about end-of-life care. There's a good section on prostate cancer and the craziness around treating it too. https://www.amazon.com/How-We-Do-Harm-America/dp/1250015766
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May 8, 2017 16:20
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SourKraut posted: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. A few months ago I went in to ER. It was determined that I had gall-stones so later that day I had my gall-bladder removed. They were able to get it with laparoscopy and I was able to walk out the next day. The hospital charged our insurance company $40,000. The majority of that from three hours of operating room fees.
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May 8, 2017 16:22
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Xae posted: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. This also leaves them with some bad debt, which can be sold to collectors or written off on taxes.
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May 8, 2017 16:32
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Cheesus posted:My wife gave birth to our son last year. It was a "normal" vaginal (non-cesarean) birth and we stayed at the birthing center room for four days total. The hospital charged our insurance company $20,000. Yep. My wife's totally uncomplicated vaginal delivery with 3 nights at hospital ran us like $6500 out of pocket with good insurance, and they charged something like 30k to insurance. loving insanity. No one can really afford medical care in this country.
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May 8, 2017 16:51
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I think pregnancies are surprisingly expensive because humans are completely terrible at giving birth compared to, like, any other animal at all, and so even if nothing goes wrong you need a lot of people on call just in case something does go wrong, which also limits the number of people you can have that are potentially giving birth at any one time.
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May 8, 2017 16:55
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LeeMajors posted:Yep. My wife's totally uncomplicated vaginal delivery with 3 nights at hospital ran us like $6500 out of pocket with good insurance, and they charged something like 30k to insurance. Cost to UK NHS for a woman to have a baby (uncomplicated birth) $3500. That's the complete cost that the NHS pays. It costs nothing for the patient.
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May 8, 2017 16:57
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We payed ~$5000 out of pocket to deliver our son despite good (and expensive!) health insurance. For reference we would have payed exactly $0 back in Canada. There's a special kind of disappointment coming from a country with UHC to the US, sort of a disbelief that the citizens of the richest country in the world tolerate such a confusing and unfair health care system. Now it looks like your representatives are working as hard as they can to make it worse and if they succeed there's no real chance of improving it without an implausibly large Democrat wave. I'd like to point out that Canada really isn't a very progressive society, in a lot of ways it's parochial with a low-productivity economy based on resource extraction and branch plants. I realize health care is a complicated issue but you have a real problem if even the Canadian government comes up with a better system. Canada used to have private insurance too so clearly it's possible to transition, although I'm guessing modern US insurers are relatively much larger than what existed in mid-20th century Canada. I don't actually understand how poor people have kids in the US. Is it just ruinous medical debt? That's exactly what new parents need.
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May 8, 2017 17:32
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BarbarianElephant posted:Cost to UK NHS for a woman to have a baby (uncomplicated birth) $3500. That's the complete cost that the NHS pays. It costs nothing for the patient.
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May 8, 2017 17:34
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Nocturtle posted:I don't actually understand how poor people have kids in the US. Is it just ruinous medical debt? That's exactly what new parents need. No, Medicaid. http://www.slate.com/blogs/xx_factor/2013/09/12/half_of_american_births_are_covered_by_medicaid_guess_who_s_to_blame.html The rates have only gone up since 2013, at this point a majority of births in the US are covered by Medicaid. The US has healthcare that should in theory cover everyone. Private insurance if you're working, Medicaid if you're poor, Medicare if you're old. The problem is that we've got huge cracks that millions of people fall through and get nothing.
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May 8, 2017 17:35
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Twerk from Home posted:The problem is that we've got huge cracks that millions of people fall through and get nothing. Usually that people are poor, but not destitute. So they work, but it's 2 part-time jobs making up the hours of one full-time job. Part-time jobs aren't expected to provide health insurance. And companies are very much aware that it's cheaper to hire two part-timers than one full-timer and have to provide insurance. This is why the eternal cry of the poor in the USA is not "Why can't I get a job?" like in other countries, but "How come I have three jobs and still can't get by?"
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May 8, 2017 17:50
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evilweasel posted:I think pregnancies are surprisingly expensive because humans are completely terrible at giving birth compared to, like, any other animal at all, and so even if nothing goes wrong you need a lot of people on call just in case something does go wrong, which also limits the number of people you can have that are potentially giving birth at any one time. there's some of that, but also hospitals insist on delivering from a laying position rather than squatting which is easier for the doctor but increases the complication rate for the mother. in addition, those "room fees" actually include all the nurses and other secondary staff involved because only doctors count as real humans with separate billable time (thus why you get both a CMS and UB claim for your delivery). Then you have the fact that every gauze they use is like a $20 charge (in case you were wondering where the title "charge nurse" comes from, they count all the chargeable supplies used and procedures done). The whole thing is pretty much structured to benefit the hospital to the detriment of the mother from the top down. How hosed it all is gets discussed pretty regularly in the feminism thread, but those discussions never happen in threads like this because MRAs instantly appear to accuse people of being hysterical and not really understanding what's involved.
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May 8, 2017 18:45
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I was mainly wanting to give you poo poo for misspelling bureaucracy, EW. I know that its not an easy fix, and I don't really think most doctor pay is remotely part of the issue.
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May 8, 2017 18:55
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Mr. Nice! posted:I was mainly wanting to give you poo poo for misspelling bureaucracy, EW. I know that its not an easy fix, and I don't really think most doctor pay is remotely part of the issue. I can't spell most words to save my life but my spellchecker must have fritzed out there 
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May 8, 2017 19:25
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If doctors salary were really that big of an issue, you would see doctor salary growing at the same rate or faster than healthcare costs. Is that happening? Nope. I'm sure you can find some exceptions in the surgical specialties but the number of those across the country is limited.
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May 8, 2017 19:31
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You can handwave all you want but at the end of the day doctors salaries in the US, particularly for specialties, is substantially higher than it is in the euro /canadian systems. Sometimes up to double. Naturally, it's of course part of the issue, along with the AMA limiting the supply of doctors to keep salaries high, fighting the use of PA's or NP's to do jobs they are qualified for and so on. Complex problems are caused by multivariate effects, but people love to dumb things down to soundbites. Reforming insurance is probably the biggest piece to the puzzle but there's other pieces to consider.
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May 8, 2017 19:51
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Lote posted:If doctors salary were really that big of an issue, you would see doctor salary growing at the same rate or faster than healthcare costs. Is that happening? Nope. I'm sure you can find some exceptions in the surgical specialties but the number of those across the country is limited. IIRC, doctors' salaries are only 10% of healthcare costs. Obviously cutting doctor pay alone won't solve the problem. Still, there is a popular attitude in the US that health care workers and especially doctors are always hyper-competent and altruistic, and so when it comes time to figure out why health care costs so much, people are loathe to try to attribute any blame to or to change what providers do and instead other parts of the health care system get to be the bogeyman.
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May 8, 2017 19:54
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evilweasel posted:I can't spell most words to save my life but my spellchecker must have fritzed out there bureaucracy is one of the silliest looking words in the language, which is pretty appropriate given what it entails. I got rid of autocorrect on all my devices because it changes correctly spelled words far more often than it actually corrects incorrect ones. My spelling has always been decent enough so the only thing that occurs really is I have a lot of lower case 'i's because I don't care to capitalize them.
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May 8, 2017 19:55
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I try to not blame doctors for health care costs since they mostly do amazing work. Plus within the past two years they have saved both me and my wife's life. Sorry for the next paragraph of words but I have more stories. For me it was a simple appendectomy after having pain all night three weeks ago. For my wife it was much more complicated and a much closer call. 15 months ago my daughter was born via cesarean birth after 24 hours of labor. Everything seemed normal in the recovery room until 30 minutes after birth her pulse dropped to 80/20, she turned extremely pale and started vomiting. Next thing I know there's six doctors rushing in poking her with needles and jabbing IV's in her wrist. After three hours of surgery I found out that on the way out my daughter nicked one of her uterean arteries and she was bleeding out. She spent 7 days in ICU and my daughter was actually discharged 2 days before my wife. The total cost was over 50k. Luckily I only had to pay about 2k total after insurance. The crazy part is I have to pay almost 2k for the appendectomy with only one day at the hospital. It pisses me off that health insurance companies are allowed to decide what they want to pay for and get away with it.
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May 8, 2017 20:08
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Rad Valtar posted:I try to not blame doctors for health care costs since they mostly do amazing work. Plus within the past two years they have saved both me and my wife's life. Sorry for the next paragraph of words but I have more stories. I'm glad that you are feeling better and that medical care has improved your and your wife's lives considerably, but it is probably wrong to assume your health care providers played no role in the cost of your medical care. Medicine and medical care is an incredible business model--people will often pay any amount of money for better health. Providers know this, and as a result, they may not worry that much about efficiency or cost.
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May 8, 2017 20:40
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Caros posted:You can do both. Saying that it is dumb without also pointing out that it is a lie isn't great. Honestly, this is the best way to do statistics in any field. Statistics without qualitative narratives misses important details (and often emotional impact). Qualitative narrative without statistics misses scope and scale.
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May 8, 2017 20:54
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Rad Valtar posted:Lots of depressing and expensive stuff First of all, im glad you guys are ok. That's scary poo poo. Having said that, I can't believe 7 days in the ICU was only 50k.... Speaks to the utter opacity and unpredictability of US hcare.
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May 8, 2017 21:08
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LeeMajors posted:First of all, im glad you guys are ok. That's scary poo poo. That was the birth and ICU combined. Maybe it's because I live in a rural area of the country.
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May 8, 2017 22:38
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Speaking of opacity: I know this is small potatoes compared to some of things you guys have been listing...but my wife had a severe allergic reaction to her medication once. Had to call an ambulance, they had to epi-pen her, the works. But that's not the cost that pisses me off...what makes me mad is that the ER doc referred her to an allergist. That allergist books her for an appointment, gets her in the office, she says she's already seeing an allergist twice a year. The ER-referred allergist pulls the records up from her regular allergist, says "Yeah, this is the same stuff we'd test you for, we're not going to do anything today" and sends her on her way. A few weeks later we get a bill. The ER-referred allergist billed our insurance for like $2,000, with a total cost to us of about $400....for looking at a record and saying "we're not doing anything". That's some absolute poo poo right there.
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May 8, 2017 23:11
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Yeah, that kind of "consult" bullshit happens all the time, and has been happening for a long time. When I brought back from botflies from Belize in 2010, the doctor I consulted with charged $500 to tell me "we think you have botflies" (no poo poo, you can see their breathing tubes, and I told you that when I came in) and then refer me to a surgeon. The surgeon charged another $800 for the consult, and wanted to put me under general because he'd never done the procedure before (he also looked a bit grossed out). Ended up finding an awesome doctor from Mexico instead who cut 'em out with local for $150...
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May 8, 2017 23:55
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Stupid anecdote below: I busted my hand last week. Broke my middle finger. Could have gone to the ER, so I went to my Chiropractor who is one of those crazies with circa 70's Xray machine. Had him do my X-ray(40$), went to my PT and had him look at it and go, "Yeap its broke, just don't smash it again and keep it taped." So I fixed his wobbly desk for him and he didn't charge me. The answer is black market medical care. We should just form collectives to kidnap doctors, like in that one episode of Firefly. Probably cheaper than insurance.
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May 9, 2017 01:11
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Rad Valtar posted:I try to not blame doctors for health care costs since they mostly do amazing work. Plus within the past two years they have saved both me and my wife's life. Sorry for the next paragraph of words but I have more stories. I am so sorry to hear that you got stuck with that.  Please tell me there is a silver lining here and that your now daughter is a roly poly beast. My son had to have a bilirubin light blanket thing, and my birth came to roughly around 2k too when all was said in done, but nothing as frustrating as yours. It seems incredibly insane to have birth cost that much when society needs births to take place in order for us to survive. The cost of giving birth alone in this country has cause me considerable pause when discussing giving my son a sibling.
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May 9, 2017 02:36
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Hastings posted:I am so sorry to hear that you got stuck with that. My daughter is in perfect health and because of what happened my wife doesn't want to go through another pregnecy. We weren't sure we wanted more then one anyway but that pretty much sealed the deal. I was suppose to get a vasectomy but two days before that my appendix had to come out so it's on hold. Funny thing is when I went to my referral appointment they failed to mention on the phone that after the doctor sees you and before you can make an appointment for the procedure they require a $400 deposit. Rad Valtar fucked around with this message at 03:02 on May 9, 2017 |
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May 9, 2017 02:59
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Medical services should be required to give a quote before services. This won't cover everything, but not everything is an emergency either. Being able to bill after the fact just shifts all cost risks to the patient, the person least equipped to do anything about it.
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May 9, 2017 03:15
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Spazzle posted:Medical services should be required to give a quote before services. This won't cover everything, but not everything is an emergency either. Being able to bill after the fact just shifts all cost risks to the patient, the person least equipped to do anything about it. I mean it sounds like a good idea on the surface but very few medical procedures go exactly as planned, so quotes would be a rough guide at best. Plus tbh you'd just end up discouraging a lot of people from getting procedures done.
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May 9, 2017 03:28
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How significant is information asymmetry in health care? My health policy knowledge is a bit lacking but part of the problem of consumers is we don't know how prices are calculated and certain procedures and tests differ insurance to insurance. However, how would that be helpful to the consumer since you don't really have a choice in health care plans. I guess it would be useful for regulators?
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May 9, 2017 03:58
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Mooseontheloose posted:How significant is information asymmetry in health care? My health policy knowledge is a bit lacking but part of the problem of consumers is we don't know how prices are calculated and certain procedures and tests differ insurance to insurance. However, how would that be helpful to the consumer since you don't really have a choice in health care plans. I guess it would be useful for regulators? Information asymmetry is massive and intentional. Consumers are kept in the dark about costs, for both good and bad reasons. One of the things the ACA is trying to do was establish some organizations to study this stuff at a Federal level. I don't know if they ever got off the ground though.
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May 9, 2017 04:03
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Noctone posted:I mean it sounds like a good idea on the surface but very few medical procedures go exactly as planned, so quotes would be a rough guide at best. Plus tbh you'd just end up discouraging a lot of people from getting procedures done. Frankly, this would fix poo poo real quick if people actually saw what was being forced down their throats.
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May 9, 2017 05:40
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BlueBlazer posted:Frankly, this would fix poo poo real quick if people actually saw what was being forced down their throats. It would kill a lot of people.
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May 9, 2017 07:52
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Noctone posted:I mean it sounds like a good idea on the surface but very few medical procedures go exactly as planned, so quotes would be a rough guide at best. Plus tbh you'd just end up discouraging a lot of people from getting procedures done. Make the medical professionals eat the cost risk, not the patients. When you get ballooning costs because any asshat can drop by your surgery for 5 minutes and charge $2000 there is no incentive to keeps costs down.
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May 9, 2017 10:23
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Peachfart posted:It would kill a lot of people. A lot of people are dying right now though If anything the massive information asymmetry shows why using market forces to distribute healthcare is a lovely idea
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May 9, 2017 11:55
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These are stupid ideas because people are not and should not be expected to be able to determine what medical procedures were needed and then pay for them out of pocket. Being the informed buyer is the job of the insurer and/or UHC org.
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May 9, 2017 12:56
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evilweasel posted:These are stupid ideas because people are not and should not be expected to be able to determine what medical procedures were needed and then pay for them out of pocket. Being the informed buyer is the job of the insurer and/or UHC org. These are 'merican ideals, though. I should get to choose my own plan! Why do I, a single white male, need maternity coverage?!
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May 9, 2017 13:11
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Rad Valtar posted:That was the birth and ICU combined. Maybe it's because I live in a rural area of the country. Anyway, among her findings was that our closest, somewhat rural hospital, 30 minutes away charged about 30% more than the more urban hospital which was about an hour away. To any conservatives in this thread, of course as informed, tech savvy consumers we did this research while I was doubled over in pain crying for the ambulance and in that calm and collected headspace, I made a rational financial decision to go for the more expensive option because OF COUSE I loving DIDN'T. I WAS IN SOME OF THE WORST PAIN IN MY LIFE AND WANTED IT TO END. But seriously, once I was drugged up in the ER and a doctor explained that I had some huge gall stones and while they could pass (painfully), I'd very likely develop them again and he recommended removing the gall-bladder. Despite thoroughly explaining his reasoning and going over the likely procedures and possible backup plans, as soon as he left my wife and I dug out our iPhones and did our research to double check his recommendations and of course shop around and after that we made a rational financial decision to OF COURSE WE loving DIDN'T! HOW THE gently caress WOULD I KNOW BETTER THAN A DOCTOR? ALSO, I WAS ALREADY IN A HOSPITAL! gently caress all of those conservative talking heads about how patients can make informed decisions about this kind of poo poo. Even if my path to surgery wasn't through a panicked ER visit and instead through a "leisurely" path of making having it removed on the advice of my personal doctor and a specialist, it wouldn't occur to me to shop around.
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May 9, 2017 14:02
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A choice between being financially hosed and being financially destroyed isn't much of a choice.
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