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Started By
Message
THE problem with our health care system
Posted on 7/24/14 at 1:52 pm
Posted on 7/24/14 at 1:52 pm
is that someone ELSE pays. Whether it's a company or government, costs rise when somebody other than the patient and doctor are responsible for compensation. Turning the government into an insurer only makes it worse. Case in point:
Abdominal CT scan w/ contrast(IV, etc)
Cash price: $404
Insurance price: $1100
EXACT SAME PROCEDURE incurs a 250% increase in cost when the third party gets involved. The cash price is affected long-term as well, as the cost curve for equipment, etc is skewed by the billable insurance price.
Insurance should be out of the picture, not fricking mandated by government fiat. The government certainly shouldn't be a fricking insurance company like many on this board suggest.
The same is happening for education. People can't really afford college without gubment help, since the colleges can charge whatever the frick they want. The easier it is to get student loans and college money, the higher the costs go. What's the magical solution? Help people afford the high costs, of course!! We see how well that works with housing too.
Why is this shite so fricking hard for people to see???
Abdominal CT scan w/ contrast(IV, etc)
Cash price: $404
Insurance price: $1100
EXACT SAME PROCEDURE incurs a 250% increase in cost when the third party gets involved. The cash price is affected long-term as well, as the cost curve for equipment, etc is skewed by the billable insurance price.
Insurance should be out of the picture, not fricking mandated by government fiat. The government certainly shouldn't be a fricking insurance company like many on this board suggest.
The same is happening for education. People can't really afford college without gubment help, since the colleges can charge whatever the frick they want. The easier it is to get student loans and college money, the higher the costs go. What's the magical solution? Help people afford the high costs, of course!! We see how well that works with housing too.
Why is this shite so fricking hard for people to see???
12
Posted on 7/24/14 at 1:54 pm to SoulGlo
Insurance doesn't actually pay that much a lot of times. Its something for the consumer to look at and say "wow, glad I have insurance". Its a racket. But I agree with your premise.
Posted on 7/24/14 at 1:56 pm to SoulGlo
Cost of health skyrockets with more state involvement, while goods subject to the market decline in price.
Posted on 7/24/14 at 2:09 pm to SoulGlo
I experienced the same pricing differential at the dermatologist.
X treatment paid by insurance $2,200 (where the insurance would only cover 50%).
X treatment paid in cash $850.
Guess which option I took.
Also, I believe the reason cash payments are set up this way are so that doctors that have their own practices can get a little pre-Obama spending money. That is, all services paid in cash don't get recorded. The cash goes straight into the doctors pocket, tax free.
X treatment paid by insurance $2,200 (where the insurance would only cover 50%).
X treatment paid in cash $850.
Guess which option I took.
Also, I believe the reason cash payments are set up this way are so that doctors that have their own practices can get a little pre-Obama spending money. That is, all services paid in cash don't get recorded. The cash goes straight into the doctors pocket, tax free.
Posted on 7/24/14 at 2:42 pm to Tiguar
quote:
Its something for the consumer to look at and say "wow, glad I have insurance"
Yes, it also has the same effect on cash payment. The cash price seems much lower to people paying cash when they see what the insurance company would pay.
Posted on 7/24/14 at 2:46 pm to SoulGlo
This isn't anything new. They need to lower prices for people paying out of pocket. The prices are negotiating prices with insurance. Unfortunately obamacare will not bring these prices down as we rely more heavily on third party payers.
Posted on 7/24/14 at 2:48 pm to SoulGlo
Very true and I can vouch for both. I work a part time job at the ER while paying my way through nursing school without loans. As for the health care issue I'd guess 50-70% of the patients that come in do not need to come to an ER but they use it as a normal primary care because they don't have to pay. I pay cash for my own medical care because I can't afford insurance. My Dr.'s visits cost me $85 of the top before any treatments every time I go. I pay him cash. But THEY come into the ER (If they paid the cash bill it would be between $600-1000 to see an ER Dr.), because they dont have to pay shite. Why not got to a primary care like I do?
As for school, I'm a nursing student and "shopped around" for my best deal when choosing a school. BY FAR the best value is the RN-ASN at the community college. I pay cash for it also. But tuition has gone up 40% since I started just two years ago. Luckily I will graduate in December before it gets stupid high. My point is you, I'm a broke arse nursing student living on $1100 a month, and I can still afford my education AND healthcare. I just live well below my means and know it will pay off in the long run.
As for school, I'm a nursing student and "shopped around" for my best deal when choosing a school. BY FAR the best value is the RN-ASN at the community college. I pay cash for it also. But tuition has gone up 40% since I started just two years ago. Luckily I will graduate in December before it gets stupid high. My point is you, I'm a broke arse nursing student living on $1100 a month, and I can still afford my education AND healthcare. I just live well below my means and know it will pay off in the long run.
Posted on 7/24/14 at 2:49 pm to SoulGlo
quote:
is that someone ELSE pays.
Correct.
However, the influence of private insurers on medical costs was minimal prior to the establishment of Medicare in the 1960s. Once Medicare (and, later, Medicaid) got into the mix, medical costs and what insurer's were charged skyrocketed.
Posted on 7/24/14 at 2:51 pm to SoulGlo
A very fundamental problem is the conflict between the moral imperative of having to help people who come into the ER versus turning someone away who can't pay. If a doctor is obligated to provide medical service regardless, there's a huge economic issue.
I'm not advocating one way or the other, but simply pointing it out.
I'm not advocating one way or the other, but simply pointing it out.
Posted on 7/24/14 at 2:54 pm to SoulGlo
Do you realize that the bill charge to insurance companies is irrelevant? Insurance companies set what they pay. It's called allowable or fee schedule. The provider takes that set rate and the patient does not pay the difference.
LINK
Scroll down and read the definition of allowable
LINK
Scroll down and read the definition of allowable
Posted on 7/24/14 at 2:54 pm to SoulGlo
quote:
Cash price: $404 Insurance price: $1100
This probably isn't accurate. I would imagine an abdominal CT w/ contrast is closer to $600 for insurance reimbursement than $1100.
Posted on 7/24/14 at 3:27 pm to SoulGlo
I believe the main part of the problem with healthcare, besides the backwards billing and cost realization methods, are that people are getting operations, procedures, and treatments that they honestly cannot afford. Some of the treatments are so expensive like cancer treatments that can be $100,000.
Do people have a right to the best possible medical care without going bankrupt? Increasingly more people are saying yes to this. I think this is something that the american people are going to have to really think about. If a person has cancer they should get treatment, but should they get the super expensive experimental treatment? I think we also need to think about the differences between treatments and cures. If a cure is expensive that is one thing to give it to some one. But if a treatment that may only extend someones life 6 months is expensive, is it worth it?
Do people have a right to the best possible medical care without going bankrupt? Increasingly more people are saying yes to this. I think this is something that the american people are going to have to really think about. If a person has cancer they should get treatment, but should they get the super expensive experimental treatment? I think we also need to think about the differences between treatments and cures. If a cure is expensive that is one thing to give it to some one. But if a treatment that may only extend someones life 6 months is expensive, is it worth it?
Posted on 7/24/14 at 3:48 pm to Stuckinthe90s
quote:
A very fundamental problem is the conflict between the moral imperative of having to help people who come into the ER versus turning someone away who can't pay. If a doctor is obligated to provide medical service regardless, there's a huge economic issue.
I'm not advocating one way or the other, but simply pointing it out
I 100% agree with you. And the crazy part is we do have "free" alternatives in this area (LSU clinics), but either these people don't know about them or could care less. Why go to a clinic (which cost the taxpayers WAY less) when you can go to the ER for the same price? Both are free to them but there's a huge difference to the tax payer. But like you said they can't be "turned away" or at least be redirected to the clinics.
quote:
I believe the main part of the problem with healthcare, besides the backwards billing and cost realization methods, are that people are getting operations, procedures, and treatments that they honestly cannot afford. Some of the treatments are so expensive like cancer treatments that can be $100,000.
Do people have a right to the best possible medical care without going bankrupt? Increasingly more people are saying yes to this. I think this is something that the american people are going to have to really think about. If a person has cancer they should get treatment, but should they get the super expensive experimental treatment? I think we also need to think about the differences between treatments and cures. If a cure is expensive that is one thing to give it to some one. But if a treatment that may only extend someones life 6 months is expensive, is it worth it?
This also. Then we are getting into a "moral dilemma". Is healthcare a right or a privilege? Person A has great insurance and is well off so they can afford the cure. Person B is not well off made bad life decisions and/or had a bad run of luck and can't afford either the cure OR treatment. So who decides how valuable that extra 6 months of life is to someone? The taxpayer definitely doesn't because they are paying either way.
Posted on 7/24/14 at 4:01 pm to MSCoastTigerGirl
quote:
Do you realize that the bill charge to insurance companies is irrelevant? Insurance companies set what they pay. It's called allowable or fee schedule. The provider takes that set rate and the patient does not pay the difference.
Glad someone knows wtf they are talking about.
That cash price is probably 2x the allowable.
2.3x - 4x more than the average allowable (across all payers) is a typical cash pay formula for medical practices.
Cash pay patients get fricked...they don't get deals. You get deals whenever you have insurance b/c you get their contracted rates.
So the cash pay patients pays $400 for that CT, the insured patient with a high deductible pays $200 for the same test. Cash pay "discounts"...are bullshite.
This post was edited on 7/24/14 at 4:02 pm
Posted on 7/24/14 at 4:30 pm to SoulGlo
quote:
Cash price: $404
Insurance price: $1100
The cash is at a discount from the facility, my employer offer 44% discount for self-pay.
Posted on 7/24/14 at 4:45 pm to GumboPot
quote:This is an excellent example. Over the long term prices will rise by the amount of the subsidy. Meaning, we will pay the same out-of-pocket, but there will be a premium to cover everyone that takes a cut to process they payment. In the end... It's more expensive...
X treatment paid by insurance $2,200 (where the insurance would only cover 50%).
X treatment paid in cash $850.
Posted on 7/24/14 at 4:46 pm to MSCoastTigerGirl
quote:Medicare sets the price they will pay based on a lot of things. Insurance companies negotiate prices with healthcare systems. The government has made billing so onerous for hospitals and doctors' offices, I could see why they would take a reduced amount for cash just to avoid all of the other bullshite.
Insurance companies set what they pay.
Posted on 7/24/14 at 4:55 pm to WW
quote:
my employer offer 44% discount for self-pay
44% off charges?
Or 44% off allowable?
Trust me, it's not the latter.
Posted on 7/24/14 at 5:00 pm to MSMHater
quote:
44% off charges?
Or 44% off allowable?
Charges.
Allowable amounts are set in contracts with insurance companies and facilities. Unless the payer goes by the Medicare fee schedule.
Posted on 7/24/14 at 6:23 pm to SoulGlo
You nailed it. The lowest cost will always be a straight line between the producer and the consumer. Throw in middlemen with no consumer oversight and you have the recipe for the mess we are in now.
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