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re: "Americans spend more on health care than anyone". What if it is due to consumer choices?
Posted on 4/23/18 at 4:07 pm to HailHailtoMichigan!
Posted on 4/23/18 at 4:07 pm to HailHailtoMichigan!
What does your data tell you?
Posted on 4/23/18 at 4:20 pm to SlowFlowPro
quote:
more socialized societies have to wait for care
They not only have to wait for care, a lot of choices are simply off the table. People conflate "socialized medicine" with the free choice to elect whatever level of care they want and can afford.
In countries with "socialized medicine", the cost of healthcare is a number on a line in a budget. The cost per person is roughly the number of people divided by that budget number. Thats what that country's healthcare costs are. In a market based care system, hundreds of millions of healthcare procedures are chosen by hundreds of millions of people.
To compare the cost of one to the other and implying one is cheaper--and therefore better-- is comparing apples to oranges.
Posted on 4/23/18 at 4:45 pm to HailHailtoMichigan!
quote:
What if it is due to consumer choices?
quote:Our system is broken.
HailHailtoMichigan
It is teetering at the tip of a butte separating two paradigms.
It will either tumble into full out socialism, or to competitive capitalism.
One or the other.
Think about it.
We now have a system of, as you surmise, "consumer choice".
That sounds like a capitalistic model.
It isn't.
Usually, such a system would entail competitive mechanisms to draw consumers. Competition drives cost down and quality up. Regulation and government interference ensures that is not so much the case here though.
For example, our system establishes that the best orthopedic surgeon on the planet cannot not charge any more for a hip replacement than a new grad from from the least favorable training program in the country. Only difference is the former is booked out for 6-9 months. Just stupid!
Our system establishes that an outpatient clinic run by a physician must operate entirely off of the physician's earnings. Rent, salaries, equipment, supplies, insurance, etc. must all be funded by returns on the MD's fee alone. However, if that MD cedes control of his clinic to a hospital, the hospital can bill a separate 'facility fee' and make a ton of money. Meanwhile the MD can keep all of his own earnings for himself. In other words, the government is willing to pay twice the fee in the latter situation for identical care. Again, just stupid.
Interestingly, hospitals tend to run such facilities less efficiently than an onsite owner. So while quality suffers, costs are driven upward.
In our system, Stark Laws establish severe restrictions on physicians' "self-referral" even when such self-referral could save major money. However, there are virtually no such restrictions on hospital systems. So hospital administrators with zero medical background are free to make personal "business decisions" directing referrals for nonclinical reasons.
The consumer is blinded to any of this. His/her post-insurance costs (deductibles) are often identical.
I could go on for pages, but suffice it to say those consumer choices you reference are rarely what they should be. They certainly have limited impact on the cost equation.
Posted on 4/23/18 at 4:47 pm to MSMHater
The ER absolutely has to run certain diagnostics if it's within reason on a differential diagnosis.
They will get the shite sued out of them otherwise.
ER physicians diagnose and make a recommendation to admit or discharge everyday.
They will get the shite sued out of them otherwise.
ER physicians diagnose and make a recommendation to admit or discharge everyday.
Posted on 4/23/18 at 4:49 pm to HailHailtoMichigan!
Haven't seen the studies that confirm that. Do we pay more at the point of service or in totality when compared to taxes taken from individuals to pay for healthcare in other countries? Both? Would like to see the numbers.
Posted on 4/23/18 at 4:52 pm to MSMHater
quote:
True, but to get the fancy diagnostics and pharmaceuticals that really hit our cost factor, they would have to pay for that, or have insurance and a diagnosis to cover the testing.
quote:True.
MSMHater
But cost for such service is disproportionately high. E.g., in the case of medicaid, the taxpayer and facility share those costs.
Posted on 4/23/18 at 4:53 pm to HailHailtoMichigan!
quote:
What if part of the reason we spend so much on healthcare is because some consumers opt for expensive, pricey medical devices, tests, new procedures, etc that aren't actually more efficient/better than the older, cheaper technology and methods?
Look over the costs associated with obesity and diabetes and consider the choices that are made (or not made) to change lifestyles. You can’t fix everything with a pill. We’re a nation of instant gratification and quick fixes, and a large portion of the healthcare epidemic can’t be fixed through either scenario.
Posted on 4/23/18 at 4:55 pm to HailHailtoMichigan!
The reason that Americans spend more on healthcare is because:
A) a lot of people overmedicate/over-doctor themselves
B) a lot of countries don’t have the means to spend a lot of money on healthcare
C) Several non-third world countries use universal healthcare
A) a lot of people overmedicate/over-doctor themselves
B) a lot of countries don’t have the means to spend a lot of money on healthcare
C) Several non-third world countries use universal healthcare
Posted on 4/23/18 at 4:56 pm to HailHailtoMichigan!
A lot of it has to do with Americans as a whole are an extremely unhealthy bunch
Posted on 4/23/18 at 5:27 pm to HailHailtoMichigan!
Nah. It's because it is a captive market. We need to pay to survive and stay in good health. So those that hold the keys to our survival make us choose between survival and money. We allow this kind of inherently coercive market to exist because a lot of people make a lot of money because of it. Most developed countries figured this out a long time ago and control the less honorable aspects of the medical market.
That, and we will spend whatever it takes to get good boner pills.
That, and we will spend whatever it takes to get good boner pills.
Posted on 4/23/18 at 5:31 pm to HailHailtoMichigan!
quote:
What if it is due to consumer choices?
What if it is due to artificial scarcity due to government imposed barriers to entry, a lack of transparency in pricing preventing customers from being able to adequately price-shop, a third-party payment model that reduces consumer responsiveness to price, a lack of feeling of choice when faced with spend or die immediately, and a culture that encourages an unhealthy life style? What if literally every facet of our healthcare system has been f&%ked by the government at the expense of consumers to make it as expensive as possible in order to justify a long creep towards a socialist single-payer healthcare system for the masses while the elite and politbureau hoard the good healthcare for themselves.
Posted on 4/23/18 at 5:33 pm to TBoy
quote:What do you perceive those "less honorable aspects" to be??
less honorable aspects of the medical market
Posted on 4/23/18 at 5:35 pm to starsandstripes
I like a lot of your ideas, but this...
You might have a hard time. Do you realize how many people in this country don’t contribute a single penny? Last I heard 50% pay zero taxes
quote:
I think part of your federal tax liability each year should include $10 to fund an auditing body to investigate fraud and so forth at the federal and state level.
You might have a hard time. Do you realize how many people in this country don’t contribute a single penny? Last I heard 50% pay zero taxes
Posted on 4/23/18 at 5:36 pm to NIH
quote:
Good point. I'll opt for whiskey over anesthesia the next time I go under the knife.
Posted on 4/23/18 at 7:25 pm to NC_Tigah
quote:
What do you perceive those "less honorable aspects" to be??
Extreme profit maximization at the expense of public health.
Posted on 4/23/18 at 7:39 pm to deltaland
quote:
A lot of it has to do with Americans as a whole are an extremely unhealthy bunch
The same freedoms we have in our crazy mixed up healthcare, are the same freedoms that allow us to eat super unhealthy everyday. We will probably never have "cheap" healthcare: it's just not the American way
Posted on 4/23/18 at 8:13 pm to cahoots
quote:Charity Hospital in NOLA was free care for the poor throughout the city. Their ER was packed constantly. Free appointments were missed and thousands in free medicine went untaken.
One problem is that ERs are forced by law to stabilize patients who don’t have insurance. Thing is, those patients often have emergencies because they don’t go to the doctor until things get to that point. Would be way cheaper to treat on the front end.
Posted on 4/23/18 at 8:21 pm to MSMHater
quote:
An ER stabilizes and sends home. ER's do not treat diseases.
But when you come in with respiratory failure, get intubated and spend a month in the hospital before you're stable for discharge you've eaten up a ton of resources that we won't be reimbursed for.
I work at a for profit hospital and we get reimbursed for about 60% of the services we perform. Of the 60%, over two-thirds is from Medicare/Medicaid which pays pennies on the dollar.
About 80% of the hospital's revenue comes from 10-20% of the patients, and a large portion of that is private donations.
It's a joke
Posted on 4/23/18 at 8:23 pm to MSMHater
quote:
don't think this holds water considering third party payers and the proliferation of HMO's, referrals, and prior authorizations.
How many billions of dollars do we spend on proton pump inhibitors? Anti-depressants? Allergy meds?
Posted on 4/23/18 at 8:25 pm to HailHailtoMichigan!
quote:
Americans spend more on health care than anyone
Because the majority of Americans don’t give 2 shits about their own health and won’t take responsibility for their own actions. Actions have consequences. Eating like shite will make you fat. Being fat and lazy gives you health problems.
None of this is rocket science but doctors/hospitals/pharmaceutical companies make too much money fighting symptoms to care to stop the cause. Hospitals would close if they didn’t have to do expensive bypass, transplant, etc. same with pharmaceutical companies. They want you to be hooked on pills your whole life. Not to fix your diet.
ETA: if you don’t believe me ask any doctor you know how much time they spent on human diet in med school. Or how much continuing education they have to do on the importance/advancement of diet.
This post was edited on 4/23/18 at 8:27 pm
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