Doris asks a good question (ploitics)

[SteamWake]

Toward the end of a question-and-answer session with workers at an advanced battery technology manufacturer, a woman named Doris stood to ask the president whether it was a "wise decision to add more taxes to us with the health care" package.

"We are over-taxed as it is," Doris said bluntly.

He then spent the next 17 minutes and 12 seconds lulling the crowd into a daze

http://voices.washingtonpost.com/44/...-word-res.html

[tater]

Worse, it's a huge tax on doctors. Both medicare and particularly medicaid reimburse below direct cost of care for doctors—specialist docs, anyway.

That does not include the doctors time at all. Meaning the doc gets paid $50 to see someone, and his rent, electricity, insurance, and staff costs for the number of minutes the patient is seen is greater than that $50 payment.

So the doc gets to pay taxes into medicare/medicaid based on their income, AND they literally have to pay money out of pocket to fix them—then they get sued if it doesn't turn out perfect.

Note that surgeons, and many other specialists cannot refuse either type of patient (or any at all, actually) from the ER. So while they can not take new patients in clinic, should either turn up at the ER they MUST see them, even if they lose money to do so.

This is not a matter of "greed," the docs don't get paid AT ALL to see them, and in fact pay for that privilege. It's insane. They cannot ever write-off such care as the charity work it is.

As a reality check, medicaid alone costs my family probably 20 grand a year out of pocket. That's enough to pay for both kids to go to private school. if you count my wife's time as worth, well, anything, it's worse. If you count her time as what it is actually worth, it's FAR worse.

This issue is important because for the bulk of the country, the largest healthcare problem is NOT cost, it's the number of docs. We get headhunter mail for the wife all the time (every other day at least) offering huge salaries to move to the middle of nowhere, or some other undesirable locale. There is a shortage of nurses, too. Nobody wants to wait 6-8 weeks to get an appointment with a specialist, but when there are only 50% of the ideal minimal number, that's what's going to happen.

[Buddahaid]

Sure, and getting a $2600.00 bill for one hour of ER time with one x-ray is way more sensible. Seems someone is making money.

[tater]

Originally Posted by Buddahaid

Sure, and getting a $2600.00 bill for one hour of ER time with one x-ray is way more sensible. Seems someone is making money.

Someone has to pay for those not paying. You'd get a bill like that at the University Hospital here—their collection rate is under 20% of what they bill. So they need to charge a lot to make up for dead beats.

Of course what the bill is has little to do with what would actually be paid. You bill $300, and the insurance sends a check for $170 and instead of dunning them, you say "thank you, come again."

That said, the facility fees are certainly a money maker. My wife waived a fee for a friend's son, and they still got an OR bill for several grand (insurance paid most of what was actually paid (less than the bill, be sure), presumably). She asked what my wife would have made, expecting it to be thousands and was surprised when she was told "Maybe $150 or $200." That was a emergency surgery, too. Hospital makes thousands, surgeon makes a couple hundred bucks. Note that her fee might have shown up on the bill as some multiple of that. It's bizarre, frankly.


tater

Someone has to pay for those not paying. You'd get a bill like that at the University Hospital here—their collection rate is under 20% of what they bill. So they need to charge a lot to make up for dead beats.

But since the Emergency Room is already paid for by the taxpayer and it already gets tax payers money specificly to pay for those who don't pay then how does that relate to his $2600 bill?
After all, how can they need to make up extra charges for those that don't pay when they are already getting paid for those that don't pay.

[tater]

Originally Posted by Tribesman

But since the Emergency Room is already paid for by the taxpayer and it already gets tax payers money specificly to pay for those who don't pay then how does that relate to his $2600 bill?
After all, how can they need to make up extra charges for those that don't pay when they are already getting paid for those that don't pay.

They don't get money to pay for those who cannot pay. They eat the loss.

This is the thing, the government CLAIMS they are paying for all this health care, but they actually pay the providers BELOW COST.

Let's say the new law made 100% of the people on medicaid or medicare. Universal care, yipee!

The problem is that since they pay below the cost of delivery, the docs/hospital loses money the more patients they see. The more they see, the more they lose.

The only way to fix this is to make the government programs pay more, and then to reduce government cost, they need to ration care. Basically less aggressive care for terminal illness (where 90% of lifetime medical costs go).

The trouble is that US patients want the docs to throw everything but the kitchen sink at THEIR cancer, they only care about saving money when it's someone else. Course this expense buys us better care. The US death rate to common cancers as a function of incidence is FAR lower than europe (particularly the UK). (the deaths per 100,000 pop at large are basically identical, but the US incidence is about twice as high)

My wife treats everyone the same, BTW, not attention to insurance, etc. It sucks that for the great care she delivers, my family actually pays money out of pocket as charity to them, and we cannot even write it off.

[AVGWarhawk]

Originally Posted by Buddahaid

Sure, and getting a $2600.00 bill for one hour of ER time with one x-ray is way more sensible. Seems someone is making money.

Therein lies the problem...why is it $2600.00 for that service? The healthcare bill has put the cart before the horse. Studies need to be done on why healthcare has sky rocketed. Throwing more money at the problem will not solve it.

[tater]

Yeah, one huge problem is a disconnect between the customer, and cost, IMO.

Insurance companies have contracts with providers, but this is usually pegged to what medicare pays---more, but some multiple. It's known by all parties in negotiation that the providers lose money on government patients, so they must be paid more. But why do costs continuously increase instead of stabilizing?

Technologies change, for one thing, and then the government sets (arbitrarily) certain reimbursements low this year that were not low last year. Since the insurers are all pegged to some multiple, revenue drops across the board. You've got employees to pay, etc, so you start doing the "brand new" technique because it pays better.

In addition, patients DEMAND the new technique.

Look at laparoscopy. Everyone demands it now. The claim is made that you recover faster, etc. In my wife's experience this is often smoke and mirrors. In academic settings, docs will have you eat a bite of solid food the next day (and I do mean a single bite), then when they publish, they can claim the patient is eating solid food XX hours after surgery instead of clear liquids for a couple days. The reality is that it might not be all that different. In addition, the new techniques take longer. Wife has a partner who is trained (fellowship) in the latest, greatest stuff. He takes a couple hours to do a case with the scope that my wife can do in 20-30 minutes open. So the PATIENT might get out a day earlier, but in return they are under general longer, AND the docs far more valuable time is wasted. 2 hours of doc time at a few hundred bucks an hour in the OR vs 1/3 of an hour. Then there is the OR time---THAT is where the huge money is, not the doc fees. Doc makes several hundred bucks, OR fees for that can be HUGE. OR is like $40-50/minute. So the lap case is 5 grand, and the open case is under a grand for OR fees. But it's not just the money, it's the TIME. Do 4-6 open cases, or ONE scoped. Those other 3-5 people are waiting X days to have their surgery done because the doc only has so many hours per week in the OR to work with.

Since there is a shortage of docs, this makes for longer wait times, AND increased costs. Sometimes the latest isn't better, or is not cost-effective.

People nowadays also misuse the ER or urgent care. Our kids only go to urgent care if they are VERY sick. Otherwise, they make an appointment with their pediatrician. The patients that complain most about waiting in my wife's experience? Medicaid patients. They don't wait any longer, mind you, insurance status has zero connection to scheduling at her office---they are just more likely to: complain, not show up for an appointment, not follow care guidelines, and oh yeah, they are more likely to sue.

There's a chunk of cost, needless tests. Since the DOC is the one who will get sued, when in doubt, order another expensive scan, blood test, etc. Also, doc shortages increase tests... really. It's 3am. Doc gets called at home. He can go in right now, get zero sleep, then still have to see 30 patients tomorrow, OR he can order some scans, etc, knowing that the patient won't be back on the floor until 5am, then he can get up normally at 6am, and see the patient when he rounds at 7:00, or maybe go in a little early if it is urgent. Sure, someone, somewhere is writing large checks for the scan, but the doc got to sleep a couple desperately needed hours, so it was worth a few grand (you don't want to be the guy operated on that next day by a doc that needs sleep, do you?).

[August]

It's more than that though.

A couple of years ago I had a minor heart attack. I went to the emergency room and inside of 20 minutes later they were wheeling me into surgery to install 2 stents in my right coronary artery. That, plus 2 days in the hospital for observation, cost 70 thousand dollars.

The last night I was in the hospital they moved me from IC down to the regular ward at 11pm since according to the hospital rules they never release people right out of IC. I wasn't there very long as I was released at 9am. That part of the bill alone was almost a thousand dollars. There is just no way that parking me for a mere 10 hours in a shared room was worth 1k.