Health Care Law is a tax

In reply to 92CelicaHalfTrac:

No, 4.5% is just G&A.

Joe Gearin wrote: I haven't read the bill, and even if I did I'm sure I wouldn't understand all the implications and legalese contained within. What I do know is this: Every other developed country in the world provides health care for it's citizens. Americans pay more for their healthcare than ANY OTHER COUNTRY in the world. Americans do not receive the best heath care in the world--- we currently rank 37th Like I said, I haven't read the entire bill, so I don't know how much crap the politicians were able to cram in there. (I'm sure there is plenty) What I do know is that our current system is flawed, and improvements need to be made. I'm not saying this is a good fix, but at least we are trying something instead of sticking with an obviously flawed status quo.

So why do all the rich people in other parts of the world come here for major medical care? And what in the world would make anyone think that the government is going to improve it? There's certainly no evidence to back up that thinking.

Otto Maddox wrote: In reply to 92CelicaHalfTrac: No, 4.5% is just G&A.

But where does the rest of it go, though? It's just a visit. The $350 charge is literally just for the 15 minute consultation.

If the remaining $334.25 doesn't go to the specialist, where does it go?

Otto Maddox wrote: In reply to 92CelicaHalfTrac: Well, it is a multi-layered problem. The hospitals pay for the drugs. There isn't necessarily a big mark-up on them by healthcare providers. I know a lot about medical practices, from one guy family practitioners up to publicly traded hospital companies. I don't know much about the internal workings or accounting of drug or insurance companies.

Yeah i can agree with this... there isn't much of a markup on drugs as a rule. I blame the drug prices on the drug companies and their advertising.

In reply to Brett_Murphy:

In reply to Brett_Murphy:

ROFL!!!

In reply to 92CelicaHalfTrac:

Probably about 50% of it goes to the doctors and nurses (including all their benefits and other costs of employment). 15-20% goes to drugs, medical supplies, etc. The rest goes to the cost of buying and maintaining the building, parking lots, equipment, etc., insurance, and tons of other little things, and of course, taxes.

bravenrace wrote: So why do all the rich people in other parts of the world come here for major medical care?...

Because we have the best healthcare you can buy. Having the best available healthcare is not in anyway the same as having the best healthcare system. Honestly, that's a pretty silly (and sadly common) argument.

Otto Maddox wrote: In reply to 92CelicaHalfTrac: Probably about 50% of it goes to the doctors and nurses (including all their benefits and other costs of employment). 15-20% goes to drugs, medical supplies, etc. The rest goes to the cost of buying and maintaining the building, parking lots, equipment, etc., insurance, and tons of other little things, and of course, taxes.

That's what i was getting at... Feels like a shell game.

92CelicaHalfTrac wrote:

Otto Maddox wrote: In reply to 92CelicaHalfTrac: No, 4.5% is just G&A.

But where does the rest of it go, though? It's just a visit. The $350 charge is literally just for the 15 minute consultation. If the remaining $334.25 doesn't go to the specialist, where does it go?

Listen to the man Otto, he works in medical insurance, he knows where it goes, and it ain't the specialist if you're wondering...

In reply to Javelin:

He knows medical insurance, I know healthcare providers. Now if we could get somebody in the drug industry, we might be able to figure this thing out.

Javelin wrote: Sorry bubba, it's not the actual *health care* that's so expensive, it's all of the other crap. The thousands of well paid administrators it takes to bill an insurer, the accountants to collect payment, the medical receptionists to collect the insurance information from the patients, etc, etc. Not to mention all of the advertising (as Ben mentioned, we are the only place where drug advertising is legal), the "luxuries" of the hospital (seriously, flat-screen HDTV's in every room? Marble counters and wood floors? Really?!?), and the lawyers to sue everybody after the insurer doesn't pay.

All the "other" stuff is a very tiny fraction compared to the health costs. What's a 22" inch flat screen - $200 maybe? A single injection of avastin will run well over $8,000 - MRI - $1,500ish, PET scan $7,500ish. Patients demand the latest tech - so you need your prostate out - the fancy robot that might let you keep your junk working is $3.5 million. If it's a medicaid patient, a hospital might get paid 5-20% of the bill 180-365 days after the bill is processed. Obviously that doesn't work very well, so hospitals need to attract patients who have either the means to pay themselves or have an insurance plan that pays well enough to keep the lights on to make up the difference. To attract those folks - well, you've seen the American consumer - it takes shiny new stuff and machines that go "ping" - so piling on more costs.

I've worked in healthcare and health insurance for a long time and I don't have a clear answer to the best fix of a berkeleyed up system - it's more about philosophical choices. The large majority of developed countries have gone down the path of a socialized health program. We have a separation between who the customer is and who pays the bills - with almost everyone except the patient receiving a financial reward for driving the costs up, not down. So my prediction, no matter who wins an election or if laws or kept or repealed...you will be paying more for your healthcare insurance and care because no one has the support or the balls to change things significantly enough to put a dent in it.

Brett_Murphy wrote:

THAT'S what I needed. THANK YOU. Everyone (myself included) thinks they know what the berkeley they're talking about, everyone thinks they're going to change someone else's opinion. I know that this bill will not lower the cost of healthcare. I know that it, like SS and Medicare/Medicaid will be used another "WE JUST WANT TO TAKE CARE OF YOU, AND THE EVIL GREEDY REPUBLICANS WANT YOU TO DIE" campaign tactic that we'll pay for, and there's not a goddamned thing I can do about it.

berkeley it. I'm gonna go drink some good beer and destroy my liver, after that, I'm going to drink vodka and watch Blazing Saddles. I may even look into how to scam my way onto Medicaid next week so you losers can pay for my dialysis.

In reply to oldtin:

You nailed it.

Javelin wrote:

92CelicaHalfTrac wrote:

Otto Maddox wrote: In reply to 92CelicaHalfTrac: No, 4.5% is just G&A.

But where does the rest of it go, though? It's just a visit. The $350 charge is literally just for the 15 minute consultation. If the remaining $334.25 doesn't go to the specialist, where does it go?

Listen to the man Otto, he works in medical insurance, he *knows* where it goes, and it ain't the specialist if you're wondering...

Heh, he's not arguing.

I know the overhead on a hospital is huge, and i'm not going to make the argument that doctors/providers are overpaid.

My only point is that these charges that i see day in and day out are completely and utterly outrageous, and they're really the reason why you can't afford to NOT have health insurance these days.

Forcing people to have health insurance fixes nothing at all, and does nothing to discourage providers from these sky-high charges.

Pulling this number straight from my ass, but i'd guess that if we made advertising for any sort of medical anything (save for elective non-medically-necessary procedures), that could be a 10-15% cut right there. Over half of that percentage coming from drugs.

If we could stop the dick waving of "My waiting room is swankier than yours!!!!" , there's another couple percent.

With that percentage drop, all of a sudden your insurance premiums are lower. Everything becomes cheaper. Everyone wins.

I don't have the solution for everything when talking about health care costs, but seriously... there some HUGE low-hanging fruit in the advertising bullE36 M3.

Joe Gearin wrote: Here: http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems and here: http://www.reuters.com/article/2010/06/23/us-usa-healthcare-last-idUSTRE65M0SU20100623 differing opinion here: http://online.wsj.com/article/SB125608054324397621.html

From your wiki link, like I mentioned:

"Journalist John Stossel notes that the use of life expectancy figures is misleading and the life expectancy in the United States is held down by homicides, accidents, poor diet, and lack of exercise. When controlled for these facts, Stossel claims that American life expectancy is actually one of the highest in the world."

Then this:

"Glen Whitman claims that "it looks an awful lot like someone cherry-picked the results to make the U.S.'s relative performance look worse than it is." He also notes that the rankings favor countries where individuals or families spend little of their income directly on health care.[7] In an article in The American Spectator, Whitman notes how the rankings favor government intervention, which has nothing to do with quality of care."

oldtin wrote:

Javelin wrote: Sorry bubba, it's not the actual *health care* that's so expensive, it's all of the other crap. The thousands of well paid administrators it takes to bill an insurer, the accountants to collect payment, the medical receptionists to collect the insurance information from the patients, etc, etc. Not to mention all of the advertising (as Ben mentioned, we are the only place where drug advertising is legal), the "luxuries" of the hospital (seriously, flat-screen HDTV's in every room? Marble counters and wood floors? Really?!?), and the lawyers to sue everybody after the insurer doesn't pay.

All the "other" stuff is a very tiny fraction compared to the health costs. What's a 22" inch flat screen - $200 maybe? A single injection of avastin will run well over $8,000 - MRI - $1,500ish, PET scan $7,500ish. Patients demand the latest tech - so you need your prostate out - the fancy robot that might let you keep your junk working is $3.5 million. If it's a medicaid patient, a hospital might get paid 5-20% of the bill 180-365 days after the bill is processed. Obviously that doesn't work very well, so hospitals need to attract patients who have either the means to pay themselves or have an insurance plan that pays well enough to keep the lights on to make up the difference. To attract those folks - well, you've seen the American consumer - it takes shiny new stuff and machines that go "ping" - so piling on more costs.

This is a big part of it, too. That, and doctors ordering said radiology because the hospital just bought their 2nd latest and greatest machine in the last 3 months and they've got to make their money back. Not necessarily because you NEED that PET scan.

But hey, "Better safe than sorry, right?" Never mind that it costs $8,000-$10,000. Insurance will take care of it and you're only on the hook for your deductible. Have a great day!

If you guys are upset about the extraneous costs involved in providing health care, well, you ain't seen nothin' yet.

Why are all those new wings being built right now? Why is the food so good in hospitals now? Why are the beds much better, the rooms much larger and all private, the LCD TVs with full cable programming and WiFi so widespread?

A new rule is going into effect where Medicare is allowed to withhold reimbursements to Hospitals and other treatment centers for patient satisfaction scores. So if you weren't pampered completely and give the hospital a bad score? The government will be withholding 1% of its reimbursements. For a mid-sized hospital, that's about $3 million a year. Plan on increased rates to non-Medicare subscribers to make up the shortfall.

In reply to z31maniac:

The U.S. has good health care, but we sure as hell pay for it. Other countries are getting equal care for far less.

And you'll need divine intervention for help if you suggest that Aunt Mary with stage IV pancreatic cancer maybe shouldn't be treated to hundreds of thousands of dollars in chemo/procedures to extend her life 2 - 4 months because - death panels.

There's interesting correlations to most advertised drugs and most used and most profitable...The bottom line is that advertising works. So advertising should be banned - then again, we're a free market system so people should have the right to promote their service....

92CelicaHalfTrac wrote: But hey, "Better safe than sorry, right?" Never mind that it costs $8,000-$10,000. Insurance will take care of it and you're only on the hook for your deductible. Have a great day!

Bingo! When somebody else pays the bills, it's always a losing proposition! Take out the 3 (now 4) parties involved (patient, doctor, insurance, government) back down to 2 (patient and doctor) and see what happens.

Hell, some doctors are trying it already: http://www.wral.com/news/local/story/8805878/

"We don't file or accept insurance of any type," Forrest said recently, noting that eliminating the paperwork involved with insurance claims saves his practice about $250,000 a year. "If you were to go to a traditional office, you see someone who's filing insurance, somebody who's doing the billing, somebody who's doing the coding," he said.

We also have a pretty convoluted method for funding medical research.

Only about one in ten drugs under development actually makes it to market, and it takes years for all the testing to complete. Even after a drug is released, if it's successful, there is still a huge potential liability if it doesn't work quite as well as hoped or it has a undiscovered side effect. So there is a huge risk for investors, who in turn require huge potential rewards.

So while a pill may only take 1$ to produce, you have to cover the millions of development costs, plus enough to cover the failed development of 9 other potential products, plus enough to hedge future liability, plus enough to pay investors a return.

Now lets say you make a great drug that will save the lives of people with a rare disease. You may only have 1,000 potential customers a year. So the price those 1,000 people actually have to pay for those 1$ pills is going to be huge. We can't charge much in other countries because we have to deal with their health care systems; so the US consumers foot the bill for the bulk of the cost. The rest of the world pays a reduced price, or just copies the drug in a generic form and sells it for something close to that 1$ production price.

We could help lower the costs by reducing the liability portion (although US consumers hate to believe that any drug could have side effects, and love big pay outs). We could try to make other countries pay more (good luck), or we could cut the prices we pay and medical research would slow down. (or we could pay more public funding, but there you're up against the same argument as publicly funded health care)

$1500 MRI? I just had one and it was only $200.

Next time you people go to see a Doctor ask him what he would charge if you paid him in cash.

Generally cash paying patients get the highest rate (unless they ask for a break - most people don't think to do this) - insurers get a contracted/discount rate, medicare - pays whatever they pay and medicaid doesn't actually send the money.