MorkandMindy

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Running the Private healthcare industry mixed in with the state-funded healthcare pushes up the prices of both because of the need to partition every cost between first payer, second payer, etc. The percentage each pays is different and depends on the procedure.

At my first blood test in this country, I asked if the health insurance would pay for it. The phlebotomist explained that if it were assumed to be for screening they wouldn't but if it was thought to be diagnostic toward treatment, then they would.

The blood-testing company would submit the bill to the insurance company three times, and if then the insurance still had not agreed to pay, then it would be my responsibility.

That was the added cost and complexity for just one simple test.
 
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MorkandMindy

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Looking at the graph it appears the government-funded contribution to healthcare should be sufficient to cover all costs for the standard of healthcare we receive.

It is insufficient because of the added cost of meeting the need to partition out all the costs.

In short, the private healthcare adds costs roughly equal to the amount of money it contributes.

OECD Healthcare costs personal and govt.jpg
 
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98cwitr

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Running the Private healthcare industry mixed in with the state-funded healthcare pushes up the prices of both because of the need to partition every cost between first payer, second payer, etc. The percentage each pays is different and depends on the procedure.

Agreed. We see clearly the spike in prices in 1976.

At my first blood test in this country, I asked if the health insurance would pay for it. The phlebotomist explained that if it were assumed to be for screening they wouldn't but if it was thought to be diagnostic toward treatment, then they would.

The blood-testing company would submit the bill to the insurance company three times, and if then the insurance still had not agreed to pay, then it would be my responsibility.

That was the added cost and complexity for just one simple test.

So how much were the tests?
 
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MorkandMindy

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Agreed. We see clearly the spike in prices in 1976.

True, the problem has been running for 50 years and with both parties, though the decline in life expectancy has been a bit more with Republicans.

So how much were the tests?

216.31 dollars, one blood test with three assays.

It's done by a private company so there's not just the staff but private yachts and airplanes to pay for.
 
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MorkandMindy

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Then ask yourself, "Why do they cost so much?" Whether it's the government paying or the individual, the price is what should concern all of us. There should be nothing that is "catastrophic" and people should be able to pay what they can. Hippocratic Oath demands it actually.

I got a $1200 MRI bill back in February, and that was after insurance paid the bulk of the total bill, which was over $6000. I've been paying $100/mo on it since then and almost have it paid off. No line of credit, no questions asked. Now, if my state's certificate of need law was repealed, it would have only been $500. The government, in my state, is driving up the cost...not lowering it.

My wife recently had an ER visit. She was there 6 hours, from walking in the door to discharge. Total charge: >$14k. That's insane. Absolutely insane.


I find this particularly annoying. I used to make the magnet part of the MRI scanner. We had a total of 100 man-hours to build each magnet at that time, and were paid 20 dollars an hour.

To boost profits the company stopped paying us a company bonus and reduced shift work pay.

And we were working for the health of the people who need the scanners, and the company charges such a mega huge amount for the scans that they bankrupt the people we care for.

Yes, I'm cross.
 
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MorkandMindy

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Sometimes you have to think about things from back to front instead.

In England one omnipresent system handles medical diagnosis and treatment: the National Health Service (NHS).

The Health insurance lobby will declare that is a lack of choice - horror of horrors!

They would say that by analogy, rather than living, it is better to die provided you get a choice of firing squads. And that is a close analogy; in the US while complexity and cost go up our life expectancy is not getting any better.

In England, the NHS supplies all medical care free at the point of delivery and is far more efficient than the mess the US has.

In England there is also the option of paying for care privately. That option is reasonably good because it has competition from competent publicly-run health services, keeping costs down and quality up.

In the US the competition is mainly from other expensive profit-driven companies.
 
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MorkandMindy

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Even more back to front:

Instead of complaining that a customer has only one main choice of healthcare provider instead of 904 bloodsuckers as in the US, to hand their money over to,

think about it from the point of delivery perspective.

With every general hospital and every primary healthcare provider in the same system,

a patient can go to any general hospital or primary healthcare provider in the entire country for treatment - maximum choice!
 
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98cwitr

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I find this particularly annoying. I used to make the magnet part of the MRI scanner. We had a total of 100 man-hours to build each magnet at that time, and were paid 20 dollars an hour.

To boost profits the company stopped paying us a company bonus and reduced shift work pay.

And we were working for the health of the people who need the scanners, and the company charges such a mega huge amount for the scans that they bankrupt the people we care for.

Yes, I'm cross.

No offense, but it would seem that 21st century technology would dictate magnetic manufacturing in an automated fashion, which would greatly reduce costs.
 
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98cwitr

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True, the problem has been running for 50 years and with both parties, though the decline in life expectancy has been a bit more with Republicans.



216.31 dollars, one blood test with three assays.

It's done by a private company so there's not just the staff but private yachts and airplanes to pay for.

Not sure what the profit margin is on that $216, but seems reasonable IMO
 
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rjs330

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Even more back to front:

Instead of complaining that a customer has only one main choice of healthcare provider instead of 904 bloodsuckers as in the US, to hand their money over to,

think about it from the point of delivery perspective.

With every general hospital and every primary healthcare provider in the same system,

a patient can go to any general hospital or primary healthcare provider in the entire country for treatment - maximum choice!

Britain's system is not all that wonderful. It has been facing a lot of issues including seeing a downturn in care and having trouble finding doctors and nurses, long wait times and higher death rates after surgeries among other things.

https://www.dailywire.com/news/7-things-you-need-know-about-britains-failing-aaron-bandler

The UK has 'one of the worst healthcare systems in the developed world'

Look I am NOT dead set against any social medicine. It is obvious that something needs to be done about our system. The costs are far too high making it very difficult for some people to get healthcare. And for those that do get it there are too many times they can't afford it. Something needs to be done. But I am not convinced that it has to be socialized.

Our government runs a HUGE deficit. They don't run anything well. Take a look at the post office or any other government program. It's not efficient and the costs far exceed what they should. What on earth makes us think that a national healthcare system would be any better? I haven't seen any evidence that it would be.
 
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MorkandMindy

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I have not been in Britain since Brexit, so I can not comment on the present state of the NHS.

However, my experience in 2014 of leaving Britain and entering the US was the NHS in England was fast and efficient, whereas in the US I had big delays when I needed to see a doctor.

And I had a big gap here in getting health insurance because I ended up having to wait for the enrollment period, and then when I got my card supposed to be valid from Jan 1st, it didn't actually start working until mid April.

Now I have been informed my health insurance will end on Dec 31st so I have to go through the joining process again and can only hope the costs will be low.

In my experience cost is not the only problem with the US 'system', there's also worry and wasted time.
 
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MorkandMindy

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No offense, but it would seem that 21st-century technology would dictate magnetic manufacturing in an automated fashion, which would greatly reduce costs.

That is what I've seen throughout the industry.

They always save as much money as possible on low-paid workers and then spend unlimited amounts on people sitting in offices.
 
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rjs330

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Actually, only a few months ago I was trying to shop for a particular simple elective procedure and found it basically impossible. It's difficult even to compare prices, much less make any realistic judgment of price against quality and service.

This is so true. In a typical market system, especially these days you can shop around for the best prices.

And often see ratings concerning businesses.

Not so with healthcare. You have no idea what your paying ahead of time for a medical service.

Now I get it for something's. Like emergency surgeries.

But I wonder sometimes if we would try we could get an answer. For example, if I had plantar fasciitis and needed foot surgery, how much would that cost? At least and estimate from the doctor. Could I get one? I don't know. I haven't tried.

Sometimes I wonder if some of this is just poor consumerism. Our own fault. I can't even remember the last time I called a doctor to finind out how much something was going to cost. Even something as simple as a sore throat. I need to get checked out. How much is that going to cost me? Can I call around and find out? If they need to do a strep test can I ask them how much that's going to be? I bet I can.

But we don't. For whatever reason we don't seem to ask these questions for medical stuff.

Is it because "insurance will take care of it?" If we had to pay our own medical costs would we be more conscientious consumers? Would doctors have to compete for patients? Offering better services, and competitive pricing?
 
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comana

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Did you call around to different doctors and get an idea of the cost before the surgery?
If you have insurance then an in network doctor will have a contract with your insurance. Problem is that it’s not something that is easy to access so you are highly unlikely to get an answer. A doctor will also have a contract with multiple insurance companies and it’s just not feasible to keep track of what they reimburse for every kind of procedure/separate billed components of procedures a doctor performs. Larger hospitals and medical groups may use a chargemaster to load all of these variables for reimbursement but your average clinic will not invest in this. Most patients never ask anyway.
 
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RDKirk

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This is so true. In a typical market system, especially these days you can shop around for the best prices.

And often see ratings concerning businesses.

Not so with healthcare. You have no idea what your paying ahead of time for a medical service.

Now I get it for something's. Like emergency surgeries.

But I wonder sometimes if we would try we could get an answer. For example, if I had plantar fasciitis and needed foot surgery, how much would that cost? At least and estimate from the doctor. Could I get one? I don't know. I haven't tried.

Sometimes I wonder if some of this is just poor consumerism. Our own fault. I can't even remember the last time I called a doctor to finind out how much something was going to cost. Even something as simple as a sore throat. I need to get checked out. How much is that going to cost me? Can I call around and find out? If they need to do a strep test can I ask them how much that's going to be? I bet I can.

But we don't. For whatever reason we don't seem to ask these questions for medical stuff.

Is it because "insurance will take care of it?" If we had to pay our own medical costs would we be more conscientious consumers? Would doctors have to compete for patients? Offering better services, and competitive pricing?

Nobody you are able to reach on the phone will be able to provide prices. The billing office has the prices, and they may not even be in the same building. They may not even be the same company. Different aspects of the services billed might even go through different billing companies. That's one of the arcane--and costly--artifacts of the US medical system.

In my own case that I've mentioned, one significant factor in total price is whether or not the doctor has the patient leave with a catheter to be removed a day later, or with no catheter. Some of the highly reputable doctors do...some equally highly reputable doctors don't. Clearly, reputable doctors disagree...but how does a layman decide whether what should be an extra cost item (maybe, maybe not after all other costs are considered) is worth it? And if a doctor doesn't--but you need one--will his he or his staff have the practice to do it as well as the doctor who does it every time?

And the hospital charges were separately billed. So was the anesthetist. Am I going to shop for them as well? Or get all their prices and total them up for each physician?

How does a layman judge the pros and cons of pricing?
 
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rjs330

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Nobody you are able to reach on the phone will be able to provide prices. The billing office has the prices, and they may not even be in the same building. They may not even be the same company. Different aspects of the services billed might even go through different billing companies. That's one of the arcane--and costly--artifacts of the US medical system.

In my own case that I've mentioned, one significant factor in total price is whether or not the doctor has the patient leave with a catheter to be removed a day later, or with no catheter. Some of the highly reputable doctors do...some equally highly reputable doctors don't. Clearly, reputable doctors disagree...but how does a layman decide whether what should be an extra cost item (maybe, maybe not after all other costs are considered) is worth it? And if a doctor doesn't--but you need one--will his he or his staff have the practice to do it as well as the doctor who does it every time?

And the hospital charges were separately billed. So was the anesthetist. Am I going to shop for them as well? Or get all their prices and total them up for each physician?

How does a layman judge the pros and cons of pricing?

Well then we are left with someone else finding that out for us.

But what if the consumer started to demand that? This is one reason why medical costs are so high. The consumer has NO control over any of it. And it doesn't matter who else is involved. We have no control, the insurance companies do. OR we have no control and the government does. And as long as insurance is willing to pay and so is government, there is NO incentive for the medical profession to cut back in cost.

Cost of services is only controlled by supply and demand. Between the provider of goods and the consumer. If the medical profession had to actually compete in the market, perhaps we could lower cost.
 
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MorkandMindy

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Well then we are left with someone else finding that out for us.

But what if the consumer started to demand that? This is one reason why medical costs are so high. The consumer has NO control over any of it. And it doesn't matter who else is involved. We have no control, the insurance companies do. OR we have no control and the government does. And as long as insurance is willing to pay and so is government, there is NO incentive for the medical profession to cut back in cost.

Cost of services is only controlled by supply and demand. Between the provider of goods and the consumer. If the medical profession had to actually compete in the market, perhaps we could lower cost.

That's also true. If the market moved 'to the right' with free-market principles and transparent pricing then prices could very well come down.

But although that makes logical sense, I'm not aware of anywhere it actually works owing to the difficulty in getting good information and being able to make informed judgments.

As RDKirk said:

How does a layman judge the pros and cons of pricing?
 
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MorkandMindy

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And there is a further complication to the free-market hope, and that is I don't think that sort of thing works anymore, for a reason that is usually outside the scope of most calculations.

And that is there are so many people with low incomes that it would be impossible to get enough money off a lot of people to settle on any particular figure as a free-market price.

The shape of the earnings curve suggests that so many low-income people would be on reduced charges that it would hike the cost for the next higher pay bracket until it was unaffordable for them too, and costs would have to be passed up to the remaining higher pay brackets.

This may appear to be an intractable problem but it isn't because the government already contributes enough money to the healthcare system to run it without private insurance contributing money too, it's just that as long as the complex billing system exists the whole thing soaks up as much money in administration as it does in health care.
 
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