The Problem With Healthcare

a reply to: eluryh22

Are you really negotiating with the insurance co? From my experience it is a take or leave it situation. The medical community says they can't make it if one dime is removed from the profit centers.

I would expect nothing less, they are protecting their businesses.

This reminds me of Walmart saying if they raised wages their world would crumble. Profits up 14%, and they raised wages.

Remember to consider who is telling you what you are hearing.

If other countries can have better care at lower prices so can we.

The problem with healthcare is that there are differenr degrees of needs but they all overlap and this creates issues. If i had to breakup healthcare service market i would look like this.

Health maintenance. A lot of costs comes from people using insurance to pay for things they should do on their own like physicals. Birth control.

Minor care. When people get sick. Colds. Flu. These quick service clinics are doing a good job of filling in.

Emergency care. True Er. Gun shots. Car wrecks. Broken bones. This type of care is really what insurance should be covering. However, insuranve often pays for the previous two categories which raises costs unnecessarily.

Major care. Again, this is the space insurance is for. Someone has cancer. Major disability. Child births. Major surgeries.

End of life care. Most of the system costs are at end of life for elderly. It is expensive to die these days. Grandma has a stroke and needs 24 hour care. Someone is terminal with cancer. Having insuranve to cover is critical.

We have insurance trying to do too much. To me the first two categoriea should be free markwt. Prices listed. Pay out of pocket.

The other categories require insurance coverage.

Not sure how to fix. Just thinking out loud.

a reply to: seasonal

Are you really negotiating with the insurance co?

I'm not sure what you are replying to. I never asserted that I negotiate with insurance companies. I do, however, negotiate with potential employers (who have separate staff that shop around for insurance and negotiates with insurance companies). One of the things that I ask for, prior to making my decision, is details about the health plan(s) they offer. Then it is up to me to decide whether or not I want to join that particular firm.

What I had said, in response to a different contributor to this thread, is that the government has no right to insert itself into my negotiations with a prospective employer, telling them what benefits (health, financial or otherwise) they have a right to offer me in exchange for what I add to their company.

Remember to consider who is telling you what you are hearing.

I'm not sure what you are referring to here. Hearing what from whom? I'm speaking from my own personal experience when it comes to health insurance pertaining to the relationship between a private employer and a private employee.

originally posted by: eluryh22
a reply to: Edumakated

Govt also needs to decouple insurance from employers.

I can not possibly disagree more with this statement. The government has exactly ZERO place inserting itself into the benefit package I negotiate with a potential employer.

You misunderstand my position. If an employer wants to subsidize your insurance i have nonissue with that. However, the problem we have now is that there is no real individual market.

Imagine if the only way you could buy car insurance was through your employer. You change jobs and then have to go get a new car insurance policy everytime.

Your shuld be able to shop for your insurance on your own. If your employer wants to subsidize it, great. But your insuramce options should not depend on where your work.

a reply to: Edumakated

This hasn't been true for 3 years. Most health care has a high deductible. This means it protect the insurance co from these little bills.

originally posted by: seasonal
a reply to: Edumakated

This hasn't been true for 3 years. Most health care has a high deductible. This means it protect the insurance co from these little bills.

Depends on your plan.

a reply to: eluryh22

our business is 15 floors of water pipes in plaster in the desert. we absolutely have flood insurance.

My home....not so much. If my home floods, the world is ending. And ill handle water leaks/damage.

Its really just a gamble. If its worth it, you pay the bookie.

a reply to: eluryh22
Costs.

Hospitals set costs someone pays them.

There is the hospitals and Dr.s saying that they are all on the edge of going bankrupt.

Insurance companies have never charged more.

Consumers have never paid more.

Something isn't jiving. When I see problems like this in any other business I know someone is making a killing.

originally posted by: intrptr
a reply to: seasonal

are we the only ones getting 3X the cost for the same or inferior quality of health care and drugs.?

You added drugs, which expands the discussion.

The problem is not regulations and laws but GREED

They charge what they can get away with, not what it costs them
Take a look at the Epipen as the first example.

fortune.com...
What Mylan's EpiPen Cost Scandal Says About the Drug Price Problem

Mylan took over the Epipen and then jacked the price up 500% until it hit a firestorm with the media.
After careful study, they still come way out ahead after reducing the price and are looking to raise the price again after the media has died out on them.

Martin Shkreli a former Hedge Fund Manager acquired Daraprim that was previously selling for $13.50 a pill and raised it 5000% to $750 a pill. He did not do further R&D on the pill but wanted to make some extra bucks off our expense.

www.fiercebiotech.com...

Martin said why does anyone have a problem with these prices since Insurance is footing the bill and patients get discounts?
Umm, you idiot, we are paying the bill in increased premiums and deductibles!!

These kind of tactics get repeated and repeated over and over again because they know the tax payers are footing the bill.

In an exchange on Twitter, Shkreli first noted that engaging with me would make my head "spin." (We have a history. Reporting a recent lawsuit Retrophin's investors filed against Shkreli--including accusations of looting the company, which Shkreli has denied--the CEO called me an idiot. Twitter is not for the thin-skinned.)

"It's a great business decision that also benefits all of our stakeholders," Shkreli then retorted. "I don't expect the likes of you to process that."

His next remark: "You are such a moron."

originally posted by: dfnj2015
The problems with our country are not rocket science. The lobbyists force the politicians to pass laws creating cartels and monopolies in exchange for campaign financing.

BINGO


www.opensecrets.org...

Top Lobbying Industries

Pharmaceuticals/Health Products $3,146,090,212
Insurance $2,190,651,832

originally posted by: Edumakated

originally posted by: eluryh22
a reply to: Edumakated

Govt also needs to decouple insurance from employers.

I can not possibly disagree more with this statement. The government has exactly ZERO place inserting itself into the benefit package I negotiate with a potential employer.

You misunderstand my position. If an employer wants to subsidize your insurance i have nonissue with that. However, the problem we have now is that there is no real individual market.

Imagine if the only way you could buy car insurance was through your employer. You change jobs and then have to go get a new car insurance policy everytime.

Your shuld be able to shop for your insurance on your own. If your employer wants to subsidize it, great. But your insuramce options should not depend on where your work.

I think what you are describing may, philosophically, be the root cause of the divide that has been growing in the United States over the past couple of decades.

There is a system in place (employer provided health insurance) that has worked very well for millions upon millions of Americans for several decades. However, since it doesn't cover EVERYONE for various reasons... rather than find ways to CREATE an individual market that is on par (or close to on par) with the current employer provided insurance system.... some people would rather destroy a system that works for millions of people in the HOPE that something as good might be formed.

In other words, rather than raise the bar we need to lower it to the lowest common denominator.

originally posted by: seasonal
a reply to: intrptr
I think you are overly simplifying a very difficult issue.

There is no competition so a 300$ MRI that is charged in other industrialized nations cost 2500$ here.

The AMA has a strangle hold on where Dr's work, how many, how many major pieces of testing equipment (MRI, CAT). The system is rigged, but now people are starting to notice and ask why, in this globalized econ, are we the only ones getting 3X the cost for the same or inferior quality of health care and drugs.?

No.

We actually get good care and we get it faster than many countries that have single payer systems. You don't hear about it, but medical tourism to the US is still a thing, not so much because our system is cheaper, but because you can get the services here in a much more timely manner.

An MRI in a single payer system can take you months on end to get in those countries where it will take you a matter of days here.

If you are in terrible pain or have a disease like cancer, months are an outrageous long time to be told you must wait. They could cost you your life. This is why breast cancer survival times are much better in the US then they are in a country like the UK -- it isn't because the available treatments are all that different but because the waiting times are sometimes that much different.

As for the drugs, part of our high cost of medication comes from those other countries and their systems. Their governments can force negotiated sales from the companies that undercut the true cost of the drug, so we not only pay for the true cost, but we also end up paying extra to subsidize those other countries. They get cheap drugs, but we pay that much for so they get that benefit. The true cost of those medicines is somewhere in between our cost and what they are paying.

a reply to: ketsuko

From what I understand, everything you've described about wait-times is completely correct.

Beyond that... people make another mistake. They think that by going to a doctor's office or hospital and not making a payment in real time... means it's free. They completely ignore the level of federal income taxes in those nations.

originally posted by: ketsuko


No.

We actually get good care and we get it faster than many countries that have single payer systems. You don't hear about it, but medical tourism to the US is still a thing,

Medical Tourism is growing not just in the US.
Your Wealthy Saudi Prince will come to the Mayo Clinic while many US Boomers will go to Mexico

www.patientsbeyondborders.com...

What are the top destinations?
Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, United States

We estimate the worldwide medical tourism market is growing at a rate of 15-25%, with inbound patient flows highest in Mexico, Southeast and South Asia.

a reply to: ketsuko

Do you have sources for some of that info. I have read extesively, on this subject. And what I see is that health care cost so much, because they charge so much.

Some stories, some new some from 2010, not much has changed except we pay about 45% more since 2010.
U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries
www.forbes.com...

Health Costs: How the U.S. Compares With Other Countries
www.pbs.org...

U.S. scores dead last again in healthcare study
www.reuters.com...

a reply to: jacobe001

Very true, I was watching a documentary and there is a huge # of people going south not just for medical, but for dental as well.

a reply to: eluryh22
Wait times, these are some stories. Canada has a little longer wait time for specialists, but over all health care is better. According to the studies.

The Health Care Waiting Game
Long Waits for Doctors’ Appointments Have Become the Norm (US)
www.nytimes.com...

Medical wait times up to 3 times longer in Canada
www.cbc.ca...

The Wait Times Alliance’s annual report card, called "Time to close the gap," said 27 per cent of Canadians reported waiting more than four hours in the emergency department compared with one per cent in the Netherlands and five per cent in the United Kingdom.

Comparing Health Care in Canada to the U.S.
www.factcheck.org...

However, on most measures of patient-reported physician quality, Canada comes out slightly ahead of the U.S. The Commonwealth Fund report shows somewhat fewer reported physician errors, lab errors, medication errors and duplicate tests north of the border, and Canadians report more satisfaction with their doctors.

originally posted by: DBCowboy
a reply to: Edumakated

We pay high insurance because hospitals charge so much because insurance pays out what the hospital bills out.

We do need to break the cycle.

This is exactly it, with the added aspect of most health insurance being paid in part by our employers, reducing the perceived cost, thus reducing the outrage of the cost.

Most of us think in terms of how much our monthly (or per paycheck) premiums are, ignoring the portion paid by our employers. That $6k per year (or whatever it is) could be higher wages, or lower prices for the goods/services produced by the companies. There's simply WAY too much money being funneled into health insurance / healthcare.

I'll add - I don't think the doctors or hospitals are making too much money, it's their suppliers and insurance companies. I used to sell surgical instruments - our cost for a cervical biopsy punch we would charge $350 for was about $26. Our competitors, the big distributors, might charge $700 for the same instrument. Then there's the pharmaceuticals...

a reply to: dogstar23

This is where there needs to be an organization that protects the consumers of an inelastic product like Medical.


In Michigan out electrical and natural gas is a heavily regulated industry. Michcon is the companies name. It works rather well.

What we have done is said, we will allow you (hospitals) to set the prices, and there is no competition. Now there is such a thing as a free market. What we are experiencing is anything but.

a reply to: seasonal

I speak from experience with my mother to determine her stroke, rehab, complex heart condition, tests, treatment and surgeries, all covered by medicare.

The determination of all that is done by a department in the hospital, they do it for you. Its a big walkin part of the hospital with many desks, 'employees', computers, filing cabinets, etc. All dedicated to mitigation with the insurance companies that have their own 'experts' making evaluations of whats to be covered and not. There are no medical personnel in there, medical equipment or treatment rooms, just desks filled with busy people on the phone and filling out forms.

Thats the extra cost for that 180 dollar howyadoin doctor visit.

a reply to: jacobe001

You also mentioned drug costs, a different category than treatment facilities.

Also, a drugs cost in hospital is astronomical because first there has to be a condition noticed y a nurse, a doctors diagnosis, a prescription written , a carrier to get the pill from the hospital pharmacy and delver it to the nurses station, and a nurse to administer it.

Thats why an aspirin costs a hundred dollars.