Merged "Bitter Pill": Major article on US expensive healthcare (Time)

[Rolfe]

I work in a veterinary lab. Actually processing the biopsy and reading the slides is about £35 I think. Although there would also be a cost for taking the sample.

And our pathologists are also MRCPath just like the human-medicine pathologists, and we're not starving.

Hah, I'm at work now so I checked the pricing from my handbook.

For a companion animal, that is unsubsidised (our government subsidises testing for farm animals), a basic histopathology processing and slide reading by MRCPath histopathologist is £28.50 (plus VAT). The maximum case charge applied if someone sends a stack of samples from one patient (usually only happens with post mortem investigations) is £80 plus VAT.

You guys are being seriously ripped off.

Rolfe.

 

[lobosrul]

Hah, I'm at work now so I checked the pricing from my handbook.

For a companion animal, that is unsubsidised (our government subsidises testing for farm animals), a basic histopathology processing and slide reading by MRCPath histopathologist is £28.50 (plus VAT). The maximum case charge applied if someone sends a stack of samples from one patient (usually only happens with post mortem investigations) is £80 plus VAT.

You guys are being seriously ripped off.

Rolfe.

Vet services in the states are also comparatively cheap. If we paid the same prices for human healthcare as for animals there wouldn't really be any problem.

 

[Bob001]

Vet services in the states are also comparatively cheap. If we paid the same prices for human healthcare as for animals there wouldn't really be any problem.

Interestingly, veterinarians' incomes have dropped in the U.S. even as the costs of getting a veterinary education have skyrocketed:
http://www.nytimes.com/2013/02/24/business/high-debt-and-falling-demand-trap-new-veterinarians.html

I'd be very cautious about comparing the veterinary business to human health care. The costs of vet care are inherently limited. A pet owner can always say, "Treating Fluffy's cancer will just cost too much. It's time to put her to sleep." I hope nobody's doing that with Grandma.

 

[Rolfe]

Indeed. However where you have directly comparable procedures which animal owners are choosing to have performed, and the vet is charging a tiny fraction of the price the human hospital is charging, you need to ask some questions.

Rolfe.

 

[Dr. Keith]

Indeed. However where you have directly comparable procedures which animal owners are choosing to have performed, and the vet is charging a tiny fraction of the price the human hospital is charging, you need to ask some questions.

Rolfe.

One issue there is liability: you kill my dog by messing up the knee surgery it may cost you a few thousand, but if you kill me by messing up a knee surgery it will be much more expensive.

Of course, the insurance companies pushed to cap liability in my fair state for med mal claims. This has worked so well that no med mal rates have dropped in our state since the passage. Yeah us!

 

[Bob001]

Indeed. However where you have directly comparable procedures which animal owners are choosing to have performed, and the vet is charging a tiny fraction of the price the human hospital is charging, you need to ask some questions.

Good point. At least one answer is that hospitals are part of giant corporations whose primary goal is to make money for stockholders (and even "non-profit" institutions make buckets of money).

From the TIME article:

The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.

http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/

 

[TragicMonkey]

You can't have it both ways. If you want your healthcare providers to make no profit, fine- but you'll have to pay all the expenses. Completely socialize everything, top to bottom. Pay our salaries from tax dollars. Everyone wins. And you can see all the actual costs so you don't have to worry about eeeeevil doctors making money.

 

[WildCat]

You can't have it both ways. If you want your healthcare providers to make no profit, fine- but you'll have to pay all the expenses. Completely socialize everything, top to bottom. Pay our salaries from tax dollars. Everyone wins. And you can see all the actual costs so you don't have to worry about eeeeevil doctors making money.

Most of your salary is from tax dollars. Even more if you count subsidies of employer-provided health insurance.

 

[beren]

You can't have it both ways. If you want your healthcare providers to make no profit, fine- but you'll have to pay all the expenses. Completely socialize everything, top to bottom. Pay our salaries from tax dollars. Everyone wins. And you can see all the actual costs so you don't have to worry about eeeeevil doctors making money.

I am in favor of this approach.

 

[daredelvis]

Most of your salary is from tax dollars. Even more if you count subsidies of employer-provided health insurance.

Evidence?

Daredelvis

 

[DragonLady]

I hope nobody's doing that with Grandma.

Of course it's being done. Just not in so many words. Right from the article:

Meantime, the bills kept coming. “We started talking about the cost of the chemo,” Alice recalls. “It was a source of tension between us … Finally,” she says, “the doctor told us that the next one scheduled might prolong his life a month, but it would be really painful. So he gave up.”

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2MJj6Urk5

(snip)

One lesson she has learned, she adds: “I’m never going to remarry. I can’t risk the liability.”

It sucks and blows; but it happens. All the crap about "death panels" made me want to vomit because there are so many people right now kissing their own asses goodbye because they just cannot pay the bills.

Does anyone remember the young man here at JREF who died of a lung disease because his family couldn't afford the $$$ needed up front for surgery?

 

[Bob001]

You can't have it both ways. If you want your healthcare providers to make no profit, fine- but you'll have to pay all the expenses. Completely socialize everything, top to bottom. Pay our salaries from tax dollars. Everyone wins. And you can see all the actual costs so you don't have to worry about eeeeevil doctors making money.

The article is worth reading in its entirety. This particular institution is officially a NON-profit organization, and its profit margin is 26% AFTER all expenses. That money might go to executives, or stockholders, or the parent organization, but it doesn't go to patient care. A majority of other industrial countries, including France, Germany and Japan, provide universal health coverage through private insurance companies, and they deliver better care at lower costs.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

 

[Dr. Keith]

Evidence?

Daredelvis

The easiest answer: most medical spending in the US is done by the government.

 

[jimbob]

Most of your salary is from tax dollars. Even more if you count subsidies of employer-provided health insurance.

Evidence?

Daredelvis

The easiest answer: most medical spending in the US is done by the government.

I made it 45% in 2007 according to the OECD


See my sig

OECD healthcare statistics

http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html
2007 Data
UK 8.4% of GDP of which 81.7% is state expenditure = 6.86% of GDP from taxes
US 16% of GDP of which 45.4% is state expenditure = 7.264% of GDP from taxes

ETA: updated was 48% in 2010 (latest data)
UK 9.6% of GDP of which 83.2% is state expenditure = 8.0% of GDP from taxes
US 17.6% of GDP of which 48.2% is state expenditure = 8.5% of GDP from taxes

 

[TragicMonkey]

I am in favor of this approach.

At least as a government employee I'll get days off. I haven't had a day off since Thanksgiving, and won't have another until Memorial Day. Too busy dealing with all the money everyone thinks we make.

 

[TragicMonkey]

The article is worth reading in its entirety. This particular institution is officially a NON-profit organization, and its profit margin is 26% AFTER all expenses. That money might go to executives, or stockholders, or the parent organization, but it doesn't go to patient care. A majority of other industrial countries, including France, Germany and Japan, provide universal health coverage through private insurance companies, and they deliver better care at lower costs.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

My employer is nonprofit. There are no shareholders, it doesn't pay dividends. Profits are put into the operation of the company- salaries (still under the local average, BTW, but there's not enough to fix that), community charity (yeah, we supply free care for some), and development (god forbid, we actually try to expand, fix old buildings, upgrade equipment, new software).

I can assure you we aren't living like kings here. We still have hundreds of computers on Windows 95. Some of out buildings are older than everyone reading this.

But heck, Time magazine says we're all evilly rich, so it must be true in every case.

 

[TragicMonkey]

Oh, and "not going to patient care" includes items like electricity. Yeah, we have to pay utilities. No, that's not considered "patient care". You want an operation in the dark? No. Do you see the electricity on your bill? No. Where does that money come from? From the "profit", the money we collect that isn't "patient care".

 

[lobosrul]

My employer is nonprofit. There are no shareholders, it doesn't pay dividends. Profits are put into the operation of the company- salaries (still under the local average, BTW, but there's not enough to fix that), community charity (yeah, we supply free care for some), and development (god forbid, we actually try to expand, fix old buildings, upgrade equipment, new software).

I can assure you we aren't living like kings here. We still have hundreds of computers on Windows 95. Some of out buildings are older than everyone reading this.

But heck, Time magazine says we're all evilly rich, so it must be true in every case.

I certainly didn't come away from that article with the impression that the average healthcare worker is making too much money, or that is in anyway at all the problem.

From what I can surmise the reason healthcare in this country is so expensive is:

1) Way more admin costs because doctors and hospitals need people to deal with multiple different insurance companies PLUS the government.
2) Insurance companies themselves have large admin costs, plus they're for profit.
3) Insurance providers for large business largely just don't give a damn about how much they're billed for. They are essentially guaranteed a profit margin.
4) Even non-profit hospitals are run like for-profit business. They do everything they can to bill their patients as much as possible. Including unnecessary procedures. Their top execs are paid huge salaries.
5) A CYA (cover your ass) mentality exists in the medical field when the threat of huge dollar lawsuits is ever present. This leads to even more unnecessary tests etc and more money spent. Plus the added cost of malpractice insurance.

 

[Bob001]

My employer is nonprofit. There are no shareholders, it doesn't pay dividends. Profits are put into the operation of the company- salaries (still under the local average, BTW, but there's not enough to fix that), community charity (yeah, we supply free care for some), and development (god forbid, we actually try to expand, fix old buildings, upgrade equipment, new software).

Forgive me for not knowing more about someone with 29,000 posts. Could you say what you do, and at what kind of institution? My impression is that "profits" as used here refers to what's left after ALL costs have been paid, including utilities and salaries. The corner grocery doesn't charge you for keeping their lights on or the salary of the cashier, but those are part of their operating expenses, and they price their products to provide a profit after overhead. Medicare prices are supposed to account for all costs relating to the product or procedure, including overhead. The article makes the point that a tremendous amount of money in the health care system is going to things like executive salaries, which can be huge.

 

[Bob001]

I certainly did come away from that article with the impression that the average healthcare worker is making too much money, or that is in anyway at all the problem.....

Did you perhaps mean "didn't?" I don't think too many people think that doctors and nurses are rolling in money, especially considering the loans that doctors have to take out to pay for medical school. They're not getting the big money.