Right, and the only way to do that is to have a powerful entity negotiating with the for profit corporations that help drive up costs - hence the government. It’s not just the hospital who is setting the costs, it’s for profit corporations that are part and parcel of our health care system, dominating it, in fact. They are standing between us and our health, I’d argue. So a public option will help, because the federal governement has regulatory powers that it can wield against corporations who care more for profits than for saving lives.
I guess part of the problem is how complicated health care has become in the past century or so. We need means of funding research in addition to funding care.
You have confused me with someone who is defending the system. The system sucks. I tried to explain the billing shenanigans behind WHY it sucks, and offered a potential strategy to try to get the same discount as the big med insurers. In my experience, you may be able to settle the bill at a discount.
Have no idea why and other people in this thread imply I am defending the status quo. I’m not, and I don’t appreciate the insinuation that I am.
Yes, exactly. Medicare For All - or any kind of Universal single-payer is only one piece of a much larger solution. It’s great for consumers but it’s just the tip of the iceberg. The cost problem is much bigger than that. It’s systemic and goes all the way up and down.
This point cannot be overemphasized. My practice stopped taking Medicaid patients because reimbursement is so poor that it does not even meet overhead costs. Not that I need to make much, but I cannot afford to lose money. In my area we are 50% Medicaid in the pediatric population, and we are a business. The expense end needs to be addressed soon.
My question is, how much of your costs would be cut by having to only deal with a single insurer, instead of multiple? Presumably, you have a team that deals with the insurance and medicare/caid billing, etc?
Agreed. I think you are both right that it’s a major part of the problem.
1/2 of my nonpatient care personnel are engaged with either government compliance or insurance. Having a more straightforward system would unquestionably cut costs. Of course, having a system that actually valued it’s children would make a huge difference, too.
IIRC, there’s pretty compelling evidence showing that free markets just plain don’t work for health care. As in, serious economists doing rigorous analysis of the data and the maths, and showing that universal health care is more efficient. Paul Krugman’s posted about it at some point or another, I think.
Pharma and medical equipment costs will kill universal healthcare if they are not controlled in some way. What has happened with the Mylan Pharmaceutical highway robbery on Epipens is just the tiniest tip of the iceberg in this area. There are few more helpless feelings than diagnosing a fairly easily treated illness and finding out the parents cannot afford said treatment. Anymore, even with insurance, the huge deductibles make it not much different than uninsured. My own daughter is on a med that runs $500/month after insurance. We can swing that, but she is 21 and not all that far from being on her own for that. Sucks on pretty much every level.
Fair enough. Just note that here in the US it indeed does have a negative impact.
How much state control is there in the Dutch system? How are costs kept low? Are they all for profit or are there companies that are either state run or non-profit?
By law health insurance is mandatory for everyone. But for profit insurance companies provide it, and there are many to ensure healthy competition. We’re free to shop around, every year if we want to. To balance this there is heavy regulation on just about everything, I’m not an expert and the system is a bit byzantine to me. But healthcare is at least 30% of government spending, the biggest single expense. Compare defense with something below 2%, we notoriously miss every NATO spending target. Funding is partly state spending and partly covered by the insurance.
I wish I could have sympathy for his plight, but I can’t. Between Thanksgiving and now, I’ve received several medical bills that cost several hundred to into the thousands of dollars, all from the same company, from procedures that have taken place over the past two years, all marked “due upon receipt”. We had zero warning that we would be hit with two years’ worth of medical bills right at Christmastime, and that would have been nice to know before we started buying stuff. Even if we spent nothing on Christmas, we won’t be able to afford this. Our credit is likely ruined.
One example is this: after my daughter had a tonsilectomy, she woke up with bleeding. At 2am, I had the presence of mind to say, hey, maybe don’t call an ambulance, that’ll be expensive. She went into the local hospital and they checked it out and suggested going to the hospital where the tonsilectomy was done, 100 miles away. My wife drove our daughter to the hospital herself. After insurance, what we owed for that visit at the distant hospital was iirc about $1000.
The hospital visit where they checked her out and suggested sending her to the other hospital, will cost us “only” $683. Before insurance, it was nearly $18,000. For an ER doctor to check her out and send her on her way. In a town where median household income barely cracks $20,000. Nearly a year’s income to be looked at. This brief visit was billed at roughly 2.5x the before-insurance cost of the tonsilectomy itself.
Instead of getting paying work done tomorrow, I’ll be arguing with them, and likely giving them permission to further ruin our credit.
I get it about the tight profit margins, but consider this: in many organizations, the highest expense is payroll. in the US, per capita income is $26,964. Average ER doctor income is around $300,000. I get it, it takes a lot of years to get through medical school, it’s a hard job, I get it. Is it worth more than 10x what the average person makes? And the nurses. Again, much respect to them for doing a hard job, but median salary for an ER nurse is about $70,000.
But maybe I’m barking up the wrong tree, because apparently in Canada, salaries are similar to the US, while medical costs are much lower. I guess it’d be crazy to expect us to at least look at what Canada is doing right.
US medical salaries are higher than the norm, and this does contribute to costs. However, the impact of salaries are heavily outweighed by the profit extraction of the insurance and pharmaceutical industries.
I live in the Netherlands, where the health system is based on for-profit insurance companies. Some ERs might also be for-profit- my local one isn’t, because my local hospital is a University hospital.
The big difference is how regulated the insurance market is. There are no co-pays, and annual deductibles are capped at about 800EUR a year. Most people have one of around 350 EUR. So you might not know how much your care will cost, but you know you will never have to pay more than a few hundred euro for it each year.
Oh, and insurance companies have to charge everyone the same for the same cover, regardless of age or pre-existing conditions- the government steps in to subsidise insurance companies for the additional cost of covering high-risk customers.
To be honest, I think the Dutch system might be a better goal to aim for in the US in terms of political achievability than something like the British NHS.
(Also, ERs in the Netherlands work very differently. If you arrive at one without a letter from your primary care doctor sending you there and aren’t actually dying, they will turn you away. Visits to primary care doctors are always free- even though they are all profit-making businesses, often with plush waiting rooms, they are paid by insurance with no deductible. If you are sick but not life-threateningly so out of office hours, there are urgent care centres- these are not free, in order to encourage you to wait if possible)
@Avyctes has also posted about this, please correct me if I’m wrong on anything.
Of course, the cost of private healthcare in the UK is driven down by the presence of the NHS- partly because of direct competitive effects, partly because private hospitals don’t have to maintain the facilities to deal with everything that could go wrong, as they can fall back on the NHS.
OK - you are not defending it - I get that - apologies. And advice on workrounds to how to mitigate its worst effects on an individual is useful, I guess. But it is the work-rounds themselves that to a significant extent allow the sytem to persist. Knowing that what they bill you - only after the event, cos they publish no prices - and then being grateful for workrounds that reduce the bill, somehow make it appear to some to be less evil than it really is. People end up grateful for small mercies not angered enough to gather their metaphorical (or otherwise) pitchforks.
If you think nurses are the cause of high health care costs, or that they (we, I am a nurse) are overpaid, here’s an example from last weekend. My friend has been a nurse for 5 years and earns 32$ per hour base pay in Denver, CO. She earns 5$/hr extra for working overnight shift. The other night she gets a sick patient with pneumonia. She is the patient’s only nurse for an hour, though she has 3 other patients (that the other nurses take care of during that hour, we use a team nursing model).
In that hour:
She starts 2 IVs on the patient, draws and send about 5-6 blood tests including two blood cultures (special technique required), gives the patient some IV fluids for low blood pressure, starts two IV antibiotics, starts the patient on a continuous IV infusion for blood pressure, inserts a urine catheter and sends a urine sample to the lab, gives tylenol and ibuprofen for fever, takes blood pressure every 5 minutes bc the patients blood pressure droped after antibiotics were started, times the pt’s chest XRay to get done during all this, charts all this in the computer system, gives the ICU RN report, and takes the patient to the ICU. A pretty standard Sepsis workup, with a very short in-ER time.
For this, the patient will be billed, well, who knows? 10,000-15,000 dollars?
(The ER MD will bill separately)
The nurse will receive 37$ before taxes.
So yeah, nursing salaries are not the problem.
That same night, the CEO of our facility will not be at work, bc they don’t work after dark. But he earns about 560$ per hour.
Along with the aspects you mention, I assume, comes a lot of single-payer-style price transparency and standardised billing to make the system more consumer-friendly and efficient.
Absent those, in the U.S. there are a whole bunch of for-profit parasite industries and careers that benefit from built-in inefficiencies. Instead of a posh waiting room (among other nice things), American general practitioners have one or more full-time “medical billing specialists” to plow through the morass of non-standardised codes of private insurers and negotiate with them to get $0.50 on the dollar.
Then there are consultants to help the patients navigate their insurance, billing collection agencies, medical supply companies that price-gouge hospitals on commodity items, etc. It’s a mess.
The NHS would definitely be a non-starter in the U.S., as most doctors would never want to appear to work directly for the state. The alternative most people here talk about is the Canadian single-payer universal system (due to geographic and cultural proximity), but you may be right that the Dutch system may be more politically feasible.
That’s speaking relatively, of course. In the end, American conservatives and the GOP won’t accept any health insurance system – including a for-profit one – that is highly regulated and puts caps on corporate profits and treats all citizens as deserving of equal treatment.
The level of often self-destructive contempt that American conservatives have for many of their fellow citizens and their “rugged individualist” delusions of grandeur are going to come across as truly alien to Western Europeans like yourself, but this is what we’re up against.
Since these “free”-market fundamentalists are so obstinate in their desire to turn everything in life into a business transaction (preferably as close to zero-sum as possible) many who are pushing for a more civilised system feel they might as well push as hard as possible for a non-profit one.
Ditto on physician salaries. At least on the primary care side, cutting our salaries would amount to a rounding error. I am in private practice peds, and do not expect anyone to sorry about me, I do not worry about where my next meal is coming from or anything, but we live very frugally on ~150k. That is plenty, don’t get me wrong, but when I hear people claiming that we are the reason medical costs are so out of control I choke a bit. Look at insurance and pharma execs, drug costs, equipment costs, and etc. Eliminating the salaries of the folks who actually touch the patients would not change the balance sheet in any significant way.
