re: How does the cost of Healthcare come down?

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Americans have to stop eating garbage and being fat as frick

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Reduce the amount of red tape that hospitals and physicians have to jump through.

For example: Dr writes an order for an X-ray and signs it, but forgets to date it. Not a valid order and hospital will not get paid despite the fact it’s obvious the patient needed it. Hospitals have entire departments whose job is to make sure the paperwork is correct. They didn’t need those departments 40 years ago.

4 things can make major changes to the cost of healthcare

1. Stop allowing insurance companies to dictate how doctors can treat their patients and pre negotiating wha they will pay for procedures

2. Get the government out of healthcare. FDA is a joke and does nothing more than run up the cost of everything. The FDA has stretched its reach far beyond it's intended purpose.

3. Allow hospitals to deny treatment to those who abuse the ER and never pay their bill. You don't take all 5 of your kids to the ER for a runny nose and a cough

4. A total overhaul of big pharma. They are not in business to cure patients. They make exponentially more money keeping you sick and putting on a band aid rather than curing the disease.

Fix these 4 major issues and our healthcare system looks completely different

Just some small examples for you.
Biden's ban on incandescent bulbs is costing every single MRI suite $1500-2000. Because they are now forced to use LED bulbs, the facility has to use a specialized kit with filters. Regular LED bulbs cause RF noise that affects the image quality of the MRI. Not a ton of money by any means, but you get the point.

FDA will not allow an OEM to use parts that differ from what was submitted to the FDA in their original drawings. This causes basic parts to skyrocket in price. One of the computers failed in a CT scanner, the power supply to be specific. OEM doesn't have a part number for the power supply but instead the customer has to buy the entire computer. Power supply is nothing special and readily available at electronics stores for less than $100 but it can't be used. Said computer is proprietary, clinic doesn't have a service contact. Their cost on the computer is $80,000. Who do you think pays for that in the long run?

I see things like this daily.

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Now with health insurance it is an elaborate Ponzi scheme to charge whatever the frick they dream up because insurance will pay it

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That’s not how it works. Insurance (CMS) sets the rates of what they will pay. Hospitals can charge $1 million for a Tylenol, doesn’t mean that’s what insurance will pay.

Insurers pay hospitals based off DRGs, or diagnosis related group. So when you ago to a hospital, your diagnosis(es) get this code. The amount a hospital is paid is based on that code. Then there are 2 ways it is allocated. One way is per diem, a certain amount per day of admission. The other is a lump sum for that code. If you need a CT scan, that’s tied to a DRG. If you need antibiotics, that’s tied to a DRG.

Physician fees are similar, but are based on wRVUs, work relative value units. Again, CMS assigns how many RVUs are attached to the CPT code (current procedure terminology). Same as above, a physician can charge $1 million to take out your appendix, but insurers will only allow $1000 to be paid.

For the person that said his hospital bill was negotiated down to $34k, that’s what the insurer said they would pay based on previously agreed upon contact. Likely $30k of that bill went to cover the OR costs and anesthesia.

For the person that said cut physicians salaries to cut costs, 8% of total medical spending is on physician fees, as evidence by the surgeon receiving $2000 of a total $34k bill, or roughly 6% of the hospital bill.

Most of the rise in cost is due to red tape. The amount of administrators has skyrocketed, most of these positions are to handle the insane amount of paperwork and red tape just to keep the doors open. With these increased government burdens, and therefore costs, together with decreasing reimbursement, hospitals in rural areas are shutting down.

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Focus on prevention of serious illness. Encourage better eating and exercise habits.

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No, no. We can't have that.

We need to spend $50-70K on triple bypass heart surgeries for idiots that have smoked for 40 years and eat like crap all their life's.

Frosted Corn Flakes and soda for breakfast anyone?

Just in the US, there are 400,000 coronary bypass heart surgeries performed EACH year.

How else is the medical industrial complex going to survive?

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Notice, the more subsidized shite is where increases outpace inflation.

Cut government handouts.
Get ppl in better shape.
Cut Medicare Medicaid reimbursements.

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You're near the target, but not quite over it.

We've fallen away from the things that made our medical system great: competition, private investment/ownership, medical entrepreneurialism.

What degrated the US System?
The short answer is government and government influence over control.
The issue is not Medicare Medicaid (CMS) reimbursement though. CMS reimbursement is exceedingly low.

The issue is associated requirements to attain any CMS reimbursement at all. That is a huge driver of cost. Further, because it's impractical to parse CMS care from private/self-pay, those CMS requirements, often painfully laborious and inefficient, are adapted throughout the care provision system adding huge amounts of unnecessary cost, and at times negatively impacting quality of care.

E.g., The opiate crisis was ENTIRELY of government making. Some DC genius decided that a good way to get around reimbursement for care was to add yet another hoop for facilities to jump though ... required documentation of pain control with reimbursement contingent on patient self-assessed comfort. If a patient said he had pain when he got home after surgery, CMS could withhold facility reimbursement. This was especially intimidating to administrators overseeing outpatient procedural discharges. So to avoid complaints, medical providers were pushed to prescribe opiates in scenarios where severe pain was not expected, but might rarely occur. In that environment companies like Purdue Pharma came forward with products marketed to the need. Then in an exquisite twist of irony, when the scope of the travesty began to unfold, HHS backed away from the pain-reimbursement equation, and audaciously sued pharma companies into nonexistence with claims pharma companies were to blame for the opiate crisis. It's a perfect encapsulation of government involvement in medicine.

Atop government imposed inefficiencies is the cost of our med mal system. As with government, the real cost there is in imposition of inefficient, costly processes which add little or nothing to quality of care. That is a completely solvable element I've discussed many times here.

The inefficiencies are further exacerbated by government sidelining MD's control in the process. The AMA is now a bought off, de facto arm of government. Stark Laws (originally passed in 1989, expanded in 1993) restricted physician ownership in healthcare facilities. Obamacare completely eliminated it. Legally disempowered, previously independent physicians, were left to seek employment under oversight of administrators and boards with no healthcare knowledge. In that system, MD clinical concerns (as with the opiate crisis) or suggested improvements are cast aside if they interfere with reimbursement.

Meanwhile, as CMS payouts do not cover the cost of the regulations they impose, those costs are meted out to private insurance, resulting in exorbitant premiums. Of course, as if it couldn't get worse, the government has also taken basic control of private health insurance through Obamacare regulation.

Further, the Government's efforts at cost control center on reduction of MDs and hospitals available. It's anticapitalist, and stupid, but that is and has been the federal plan for 30yrs.

Instead we should:
• Expand the number of MD training programs, thus expanding MD "supply" and pushing cost down.
• Eliminate MD facility ownership exclusions.
• Eliminate Certificates of Need (CONs) required in many instances to open competing facilities.
• Implement a no fault, Euro-style med mal system
• Form a CMS-DOGE panel to examine all CMS regulations in terms of risk, benefit, and cost.
• Eliminate Obamacare requirements and subsidies.

So again, the issue is not level of CMS reimbursement. The issue is regulation, bureaucracy, inefficiency.

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pickle311

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Good post

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Truth be known, we have to get good with letting people die.

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Ok. You go first…..

This. For anyone who remembers, before we had whole health insurance, it wasn’t close to being as expensive as it is now (even adjusted for inflation).

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This is a big part. There's this ER room here that my wife went to because she wasn't feeling well. They made her take a catscan that they billed our insurance $20k for (which wasn't needed imo). Our neighbor had the exact same story there also.

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i get nagging neck pain from sleeping the wrong way that normality goes away by the next afternoon. A few years ago it stuck around for a couple of months so I went to the Dr. He ordered an x-ray for over $500 and looked at the results for 2 secs and says you need an mri. $5000 later he said here's an appointment to a spinal surgeon. I canceled it and went to a chiropractor and for $25 i was fine the next day. Maybe it was a coincidence but that's what happened. I spent $5500 and got exactly zero "care."