Health care - administrative incompetence

[xjx388]

Yes, you said

Touché and vice versa.

Yes liver transplants are basic health care: hotel services aren't. Do you honestly disagree with that?

I don't think liver transplants should be considered basic medical care. It's funny how in the UK, a simple and inexpensive procedure to correct a person's vision (Lasik) and improve their QOL is NOT considered "basic medical care" but a complex, risky and scarce treatment like liver transplants are?

And now that I've got Lasik in your minds, isn't it amazing how the free market has whittled the cost of this procedure to a mere £395 per eye? It used to be much more expensive than that but competition drove it down. How can you argue that other procedures, even transplants, wouldn't be the same?

 

[RemieV]

Touché and vice versa.

I don't think liver transplants should be considered basic medical care. It's funny how in the UK, a simple and inexpensive procedure to correct a person's vision (Lasik) and improve their QOL is NOT considered "basic medical care" but a complex, risky and scarce treatment like liver transplants are?

And now that I've got Lasik in your minds, isn't it amazing how the free market has whittled the cost of this procedure to a mere £395 per eye? It used to be much more expensive than that but competition drove it down. How can you argue that other procedures, even transplants, wouldn't be the same?

What?

A liver transplant saves a person's life.

Lasik makes it so... they don't have to wear glasses?

How on earth are you making this comparison?

 

[xjx388]

Here's some reductionist logic for you:

Fact: Health care needs are unpredictable and can be extremely expensive.

Granted.

Fact: Self-insurance is extremely impractical and simply not possible for most people. We require liability insurance for automobiles. As far as I know you can self-insure by depositing the full cash amount with the appropriate entity (think $30,000 cash you cannot touch). Once that's wiped out in an accident, you have to bring it up back up to $30,000 to be self-insured again.

Ok.

Fact: If everyone took that much money out of circulation, it would cripple the economy. If one person in 100 per year (numbers out of my ass) needs $50,000, it's much better for the economy if each person pays $600 (a little extra for profit/administration) than for everyone to keep $50,000 in the bank (that would be $5M not in circulation).

Poppycock.

Fact: Each individual insurance company has to pay for infrastructure (rent, sales, administration) and take a profit, which by definition becomes less of a burden when there's only one entity.

But that one entity has no incentive to lower costs. Look at everything the government runs and you will see nothing but bloat and waste.

Fact: As someone who runs a practice, you should know that unless everyone pays cash, you will still need to perform administration to deal with the various insurance companies. Unless insurance is completely eliminated, this burden remains, which increases costs that you must pass on.

Correct, that's why I can't do it now.

So, in theory if everyone could pay cash, administrative costs would go way down. However, as we can clearly see, that's never going to happen.

Why not? Why will this never happen but one-payer can?

Even if people manage to budget large amounts of money, there will be those who go bankrupt and be unable to pay their bills. Who's going to pay? You and me because every business factors in bad debt when setting their prices.

No, some kind of safety net insurance plan.

So, if we're going to be paying for people anyway, why bankrupt them in the process? Who does that benefit?

We don't have to pay for them.

The fact is that the USA has the highest rates of spending on health care yet by most objective measures lags behind in outcomes.

I don't agree with this. We're at least equal in most areas, better in others, worse in some.

As for where the money comes from, it comes from the same sources it does now. Only instead of going to insurance companies, it goes to a single payer entity, namely the government.

There's no guarantee the government can do a better job. How do you like your school system, UY? We lag far behind other countries in Math and Science.

Last Fact: In the USA we're already paying X billions of dollars on health care. If costs remained exactly the same, we as citizens would still be paying the same amount. Only people wouldn't be going bankrupt. The money is already there, so it's rather silly to ask where it comes from.

There's no guarantee costs will stay the same and every indication they will go up under a one-payer system. The nation will go bankrupt to say nothing of individuals. It's silly to think costs will go down or stay the same.

 

[Tatyana]

The lab calls our office immediately with the panic values. We find the patient and get them help.

What happens out of hours at the clinic?

 

[xjx388]

What?

A liver transplant saves a person's life.

Lasik makes it so... they don't have to wear glasses?

How on earth are you making this comparison?

Well, simple, inexpensive procedures that improve quality of life and end up being cheaper in the long run are not considered cost-effective and thus are not basic medical care.

Yet, procedures that may extend life but carry high costs, risks of failure in 10%-15% of cases along with the lifelong care necessary are basic care.

Why not cover the Lasik?

 

[xjx388]

What happens out of hours at the clinic?

Our Doc will get the call from the answering service after hours. She has access to the medical record from home and she makes every effort to contact the patient to tell them what to do. Most times, she meets them at the ER unless she's out of town, in which case the hospitalist group takes over.

Where are you going with this?

 

[Agatha]

But we pay less here as a % of GDP for broadly similar outcomes. Why do you assume that providing decent healthcare to all free at the point of use would cost you more? It doesn't cost us more.

 

[Ivor the Engineer]

<snip>

Why not cover the Lasik?

Because glasses are more cost effective.

 

[xjx388]

Because glasses are more cost effective.

Cite your source for this because it doesn't make sense to me.

 

[kellyb]

But we pay less here as a % of GDP for broadly similar outcomes. Why do you assume that providing decent healthcare to all free at the point of use would cost you more? It doesn't cost us more.

We'd have to do a LOT more than just have taxes paying the bill to get our costs in order. We'd need our government to bargain for bulk pharma purchases and medical device purchases, get rid of insurance companies being paid to manage Medicare, eliminate private for-profit lab and radiology companies, etc.
There are lots of hands in our present health care cookie jar, and they "own" our politicians.
US Democrats seem to be in denial about how totally sold out our politicians secretly are to these special interests, and Republicans are ideologically opposed to eliminating these private profits which inflate our costs on so many levels.

 

[Tatyana]

Our Doc will get the call from the answering service after hours. She has access to the medical record from home and she makes every effort to contact the patient to tell them what to do. Most times, she meets them at the ER unless she's out of town, in which case the hospitalist group takes over.

Where are you going with this?

I am just wondering how things work.

For example, do doctors still do house calls?

 

[xjx388]

But we pay less here as a % of GDP for broadly similar outcomes. Why do you assume that providing decent healthcare to all free at the point of use would cost you more? It doesn't cost us more.

It all goes back to the cultural differences we spoke about earlier.

Maybe it will work, I can't say for sure. My gut tells me it won't but I could be wrong. What I want is concrete answers as to how it can possibly be implemented without increasing costs or reducing the relative value of skilled work. It will not work otherwise.

 

[Ivor the Engineer]

Of course it's ideological. Your position is ideological as well and I find it to be equally full of woo and ignorant of economic reality.

You have repeatedly demonstrated that you don't have the first clue about economic reality. You have obviously got your education from the right-wing media and the Republican party. Here are the basic facts you need to learn: Healthcare isn't a free market and it never will or can ever be a free market. I've already explained why. That's economic reality.

And people ARE saying that everyone is entitled to the best healthcare. The idea seems to be that the "Best Healthcare" means you get a private room or more time with the doctor. But liver transplants, an extremely costly and delicate surgery that requires exquisite skill to perform, is basic healthcare.

Not everybody needs liver a transplant. The US economy could easily cover the cost of providing everyone who needed a liver transplant having one if enough organs were available under a universal healthcare system.

I suspect what really gets your goat is the idea of having to subsidise the cost of other people's heathcare.

And so many of you seem to think that doctors making money = bad. From what I can find, the average surgeon makes the equivalent of about $150,000 in the UK. That seems like a lot and it's probably more than most people make in the UK. Fine. But why is it bad for a transplant surgeon to make money when they supply such a valuable skill? What about pop stars, athletes, actors, etc.? All they do is entertain us, which is not saving anyone's life, yet the best of them make well over $1,000,000 per year. How are our values so screwed up that we reward the least skilled and tell the most skilled that they are comparatively worthless?

Yet more evidence you don't understand the economic problems with a market in healthcare.

 

[xjx388]

I am just wondering how things work.

For example, do doctors still do house calls?

Ours does, but it's exceedingly rare. Insurance/Medicare/Medicaid doesn't cover it for the most part, but our doc just thinks it's good care in select cases.

 

[jimbob]

Because glasses are more cost effective.

Cite your source for this because it doesn't make sense to me.

For starters there is a finite risk with any surgical procedure. There is no risk associated with trying on a pair of glasses.

 

[Ivor the Engineer]

Cite your source for this because it doesn't make sense to me.

Having Lasik doesn't guarantee you will not need glasses. My mother has had it done (it cost a lot more than £395/eye, BTW) and she needs glasses for reading and other close work. It also isn't suitable for everyone.

Being a surgical procedure Laslk also carries risk of complications, including infection and permanent damage to vision.

 

[xjx388]

You have repeatedly demonstrated that you don't have the first clue about economic reality. You have obviously got your education from the right-wing media and the Republican party. Here are the basic facts you need to learn: Healthcare isn't a free market and it never will or can ever be a free market. I've already explained why. That's economic reality.

Information asymmetry is not necessarily a barrier to free market health care. You assume that doctors will gouge because they know more than you do. That's left-wing propaganda: "Doctor's are greedy!"
Milton Friedman didn't think it was a problem and he was an economist. He expressed my position much better:

There are four ways in which you can spend money. You can spend your own money on yourself. When you do that, why then you really watch out what you're doing, and you try to get the most for your money.

Then you can spend your own money on somebody else. For example, I buy a birthday present for someone. Well, then I'm not so careful about the content of the present, but I'm very careful about the cost.

Then, I can spend somebody else's money on myself. And if I spend somebody else's money on myself, then I'm sure going to have a good lunch!

Finally, I can spend somebody else's money on somebody else. And if I spend somebody else's money on somebody else, I'm not concerned about how much it is, and I'm not concerned about what I get. And that's government. And that's close to 40% of our national income.

So many applications to education, defense spending, agricultural subsidies and yes, Healthcare.

Not everybody needs liver a transplant. The US economy could easily cover the cost of providing everyone who needed a liver transplant having one if enough organs were available under a universal healthcare system.

Could it? Can the NHS? Are you telling me there are NO denials? I don't believe you.

I suspect what really gets your goat is the idea of having to subsidise the cost of other people's heathcare.

Yuppers. I want to spend my money on myself. I want you to spend your money on yourself. That way we all have incentives to control our costs. I don't want someone else spending my money on someone else. What am I getting for 38% of my hard earned income they already take out of my pocket? Try to suppress your emotional reaction.

Yet more evidence you don't understand the economic problems with a market in healthcare.

And you don't understand the advantages of the free market. You've been marinated in a single-payer system for so long that you can't see past it.

I'm trying to wrap my head around the advantages of a single-payer system and I do see a lot of people's points here. I'm reading as much as I can. But I don't like the way it devalues the skill-set that doctors have. Why are their life-saving skills worth less than a pop star? I also don't like the way the government system devalues educators. They are responsible for shaping our children's future, yet we pay them like trashmen. It's shameful, really that Britney Spears and her ilk live in mansions and party their lives away when the people that provide REAL VALUE to society are dismissed as greedy crooks.

 

[jimbob]

And so many of you seem to think that doctors making money = bad. From what I can find, the average surgeon makes the equivalent of about $150,000 in the UK. That seems like a lot and it's probably more than most people make in the UK. Fine. But why is it bad for a transplant surgeon to make money when they supply such a valuable skill? What about pop stars, athletes, actors, etc.? All they do is entertain us, which is not saving anyone's life, yet the best of them make well over $1,000,000 per year. How are our values so screwed up that we reward the least skilled and tell the most skilled that they are comparatively worthless?

Where has any poster said anything about limiting the income of medics? In other threards alt least (and possibly in this one) it has been pointed out that many NHS consultants also have private practices, in addition to their primary NHS practices, and often use the same NHS facilities for the private practice - which benefits the NHS by paying for the resources.

Earlier on I asked if my calculations for the costs for surgary was incorrect. We could probably see what sort of costs Ducky's treatment entails, and it would be pretty expensive. I doubt he would be a profitible prospect for any insurer anyway.

Do you disagree with my calculations. $1.2 million doesn't seem surprising at all. But I am only an engineer in a capital-intensive industry.

Why should insurers be forced to take on unprofitible customers? Why should people find medical insurance prohibitive simply due to an accident of medical history?

The answer is universal healthcare.

How so? In a free market, if enough people choose not to buy commodity x because it's too expensive, then the price of commodity x has to come down.

ETA2: added in post to which I was mainly responding:

How, exactly, would you have had me budget for 1.2 million dollars in healthcare costs for cancer over the past 7 years (a significant amount of which wasn't covered under insurance?)

In our current system, I wouldn't. 1.2 million is a crap-ton of money and there's no way it should cost so much. You indicated that the insurance didn't cover much of that figure. Are you saying that your out-of-pocket is 1.2 mil or that the total bill was 1.2 mil, the insurance paid a chunk and you are left with a chunk? If so, what was your chunk?

It's hard to argue when the argument becomes personalized in this way. I'm not trying to offend you and I apologize if I did so, sincerely.

I did some calculations earlier, and I'd like you to answer where they are wrong:

Individuals can soon run up costs that are excessive. That is why we need some pooling of risk to as "insurance". You need some administrative overhead, and I'd contend that the US has a wasteful system.

You are wrong that the poor are not an attractive market.

Walmart has done pretty well suppling to the poor.

But they wouldn't make any money in selling inherently expensive treatment at below cost.

According to this the median net worth of a renting household was $4k in 2004 (if I am reading the data correctly)

How could a household with a net worth of that actually pay any more than $4k for anything? Especially as they are likely to be poor credit risks, so borrowiong the money would be difficult.

Can we get the coronary healthcare cost below $4k?

5-hour bypass surgery: General surgeon with less than 1-year experience, $170k, Anaesthetist , less than 1-year experience, median salary $145k.

Both work 60 hour weeks for 50 weeks a year. This means that their combined equivalent hourly rate is $105/hour.

Now they are not performing surgery all of that time, so the actual money that the they are paid as an hourly rate whilst in theatre has to be higher.

As well as the two highly-skilled doctors, you need support staff, (in one photo, the team seemed to be four people), so that makes two other wages that need paying directly during the surgery.

You also need to pay for the use of the theatre, and expensive equipment, say $3million, depreciated over 5-years, when the equipment is in yse 52 weeks per year, gives a theatre cost of $11.5k/week. Now the theatre can't be in use all this time, there has to be preparation, so (generously) we could also assume a 60-hour week for the theatre, which gives $190/hour just for the theatre. Actually it will cost a lot more than this, but I am making a conservative point.

So far just taking the cost of the theatre depreciation and the salaries of the surgeon and anaesthetist, both at the bottom of their respective pay scales, and both working 60-hr weeks in theatre, we get to $295/hour, or $14745 for the five-hour surgery.

You could probably double this for more realistic utilisation rates.

You now need to add in the cost of the other two team members, and of the provision of facilities, and of the proportion of the hospital capital cost that is being depreciated (say over 30 years), and the cost of the bed and accomodation over (three days) stay in hospital.

It soon costs more than the $4k that these people have.


Rolfe works in a free-market system providing medical care to animals, so I will ask him her this next question:

If someone's pet needs treatment that costs more than they can afford, do you (as the representative of the free market pixie) reduce the price of the treatment, or does the animal not get any treatment?

ETA: corrected one typo, and one misconception from the original post (in blue)

 

[Agatha]

What on earth does the amount of money Britney Spears earns (in America, no less) have to do with the earning potential of doctors?

And who is dismissing doctors as "greedy crooks"? You are, and not for the first time, ascribing positions to people which they do not hold. Nobody in this thread, based on this side of the pond, is begrudging the earning power of doctors or nurses or midwives or physios... on the contrary, most people over here would like them to earn more.

 

[kellyb]

Yuppers. I want to spend my money on myself. I want you to spend your money on yourself. That way we all have incentives to control our costs. I don't want someone else spending my money on someone else.

I hope you don't pay for insurance, then, because most of the money you pay to an insurance company goes to paying for someone's else's healthcare (plus company profits and CEO millionaire salaries.)