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Health care expenses are out of control

Discussion in 'Health' started by Dr.Who, Oct 17, 2008.

  1. Dr.Who

    Dr.Who Well-Known Member

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    Insurance costs are very high. As are doctors bills and the cost of medicine.

    And who do I blame? Well there are several causes. I know some of you will say that years ago there were hardly any treatments available compared to today it cost less. Comparing costs of yesteryear with costs of today would be like going into a Wal-mart in which there were mostly empty shelves. Why of course your cart would be mostly empty when you left and your resulting bill would be smaller compared to going into a fully stocked Wal-mart with a one-day sale on everything. Today we do have fully stocked health care shelves but we don't have a one-day sale.

    What we have today, to continue the Wal-mart analogy, is a situation in which we can put whatever we want into our carts and never need to ask how much it even costs. Then our employer's chosen buying club pays the bill. All we have to do is pay the fee to join the buyers club. We don't get to decide who the buyers club is and we don't get to know how much the items in our cart cost until after we go home.

    Now tell me what do you think would happen to the cost of goods at Wal-mart if they knew that you the consumer were never going to look at the price when you put stuff in your cart? What would happen to the size of your overall bill if you could put whatever you wanted into your cart when you wanted to and all you had to do was let you boss pay the bill? Obviously the price of the stuff would go up. Obviously the bill your boss pays would be high. And obviously he would just consider that to be a part of your wages and pay you less.

    If you want to be a part of a collective of buyers clubs that your boss chooses for you it would be really easy to make that happen. Just ask congress to make sure that any money you take home in your paycheck is taxed and any money that your boss pays to the buyers club is untaxed. Voila!

    So how do we get back to lower prices on health insurance and health services? First let everyone choose their own health insurance company. It is virtually criminal to create a system in which your boss makes those choices for you. Second let you work out for yourself how you want to deal with your health insurance company. Do you want a deductible and lower premiums or do you want no deductible and higher premiums? That is no one's business but your own. Do you want a co-pay and lower premiums? Again that is up to you. But people who have even small, $10, co-pays and small deductibles ask their doctor how much it costs for an exam or for a procedure. And people who get to shop around for their doctors choose good doctors who cost less than good doctors who cost more. This is just competition and it is a simple idea that has proven itself to work very well for a long time.

    We got into this mess when congress made it so that health premiums, when paid by employers, were not taxed (pre-tax money).

    The correct solution is the one that is being talked about now. If the employer buys your insurance for you (and takes away your choice) then call it what it is - compensation. And tax it like your other compensation is taxed. But at the same time don't tax you when you buy health insurance yourself and make the choice yourself.

    When you consider every kind of health insurance that people buy today - including insurance that pays for every imaginable contingency, every cosmetic surgery, and gives one every perk, then the average costs of health insurance is about $12,000. But that is not realistic. The average cost of health insurance when it just pays for, well, normal health expenses, is $5800. And the current proposal would give everyone a credit of $5000. So the costs of expenses only needs to go down by $800 per year for the savings to be larger than what we are spending now.
     
  2. Mr. Shaman

    Mr. Shaman New Member

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    ....And, more Federal-subsidies for health-insurance providors!!!

    I mean...Hell....look how well that's worked, to-date!!! :rolleyes:

    In eight years, have you "conservatives" ever been right, about ANYTHING?? :rolleyes:

    Ya' had your shot....and, the clock ran-out. It's your turn to ride-the-bench.
     
  3. Dr.Who

    Dr.Who Well-Known Member

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    By no means should there be any subsidies for health care providers. They should operate as a business and either succeed or fail on their own. Those who have been offering subsidies for health care providers are not acting as conservatives so there is no use blaming conservatism for that.

    And I guarantee you that the system that created this health care mess, like making employers offer health insurance and taking away free choice and competition, existed long before 8 years ago.

    Free markets and competition are what this country has operated on for most of it's hundreds year history so yes that has been done right for a long time. More recently our country has taken a turn towards socialism. We have become more and more socialistic, allegedly redistributing the wealth from rich to poor and yet the only thing that has produced is an even greater divide between rich and poor than this country has ever seen.

    Clearly many of the ills of this country are the result of liberal policies that have been around longer than the last 8 years but have also increased as a result of the liberal congress which is more powerful than one President during the last 8 years.
     
  4. Dr.Who

    Dr.Who Well-Known Member

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    I just noticed that you had a link in your post about the "health care subsidies to insurance companies".

    Did you read that article you linked?

    The subsidies were funds given to individuals so that they could pay their COBRA insurance when they lost their jobs. And the Democrats complaining about the program were complaining that it was not big enough so they wanted to increase it from 11 billion to 16 billion. Obviously the real reason for the complaint is that a Republican president offered the plan first.

    The only people, according to your source, that had a real complaint with the subsidies (to individuals through states) were conservatives who worried that they could result in increasing prices for consumers. So who is worried about consumers and who is worried about politics here?
     
  5. karrma

    karrma New Member

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    I am a doctor, and have not ever seen a patient with insurance that pays for everything. Maybe where Senator McCain lives, but not around my town.

    The cosmetic surgeons in my town, and all others that I known, don't take insurance at all. Its pay before you play. They do keep busy. I would like to have the same, agree that Doctors were not as smart at negotiating contracts as the insurance companies were, should have let the patient pay the doctor directly and then the insurance re-imburse the patient, the way it originally worked.

    I do see patients all the time, who will have a $18,000 a year prescription to pay, or lose their job due to illness and disability that the medication is preventing. They will not be able to get insurance for anywhere near $5000. Insurances do not work that way for individuals, only if you buy in bulk.

    McCains plan also decreases states rights, decreases state regulation, doesn't make sense if he is a Federalist. Currently the state insurance commission regulates the health insurance, and I can vote in or out an insurance commissioner that is not being fair to me or my patients. McCain's plan will erode that right, as he would allow insurance in one state to be regulated by the insurance commissioner in another one. (see my new thread on insurance commissioners and health care)
     
  6. Dr.Who

    Dr.Who Well-Known Member

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  7. karrma

    karrma New Member

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    Hi Dr. Who,

    Great questions. I am new here, thank you for being someone with ideas, not just emotions.

    Yes, in this thread, questions were on health care costs, and I do have more ideas on how it started, rather than how to get out of the mess. Much of it relates to health care getting away from primarily the patient and doctor relationship, where the patient knows exactly and immediately how much it costs. Can we go back to this? Negotiating individually with insurance companies, we have little power, and negotiating as a group, we are racketeering.

    I am sure you have also heard of Tort reform.

    The questions I was asking were in relation to Senator McCains last presidential debate, as this is a political forum, and I am trying to figure the logical results of his plan.

    He did declare himself a Federalist during his answer on his health insurance program.


    According to the semi-reliable site Wikipedia on Federalist:

    In reference to the historical political party and as defined by Merriam-Webster, someone favoring a strong centralized national government.

    In contemporary usage, as articulated by president Bush's New Federalism, federalists advocate the principle of greater regional autonomy within the United States—usually by allowing individual states to set their own agendas and determine the handling of issues, rather than trying to impose a nationally uniform solution.

    I believe John McCain was using this word in the second sense, based on context.


    On the question of insurance commissioners, yes the vote is based on me as a state citizen not as my role as physician. The insurance commissioner only wants to hear petitions from the involved citizen.

    The urgent question I want answered, is will allowing health insurance companies regulated by one state, to offer insurance in another state, help or hinder true states rights, and is it going to promote deregulation of the health insurance companies. Right now, based on my prior experience, it will deregulate the health insurance companies more, making them more powerful. I am concerned it will decrease the ability for me and my patients to negotiate for what I would judge as necessary and allowable procedures or treatments. Believe me, there are times when we as doctors need to advocate for our patients with the insurance companies.
     
  8. PLC1

    PLC1 Moderator Staff Member

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    Health care costs are, indeed, out of control. The average cost of health care has gone up much faster than the rate of inflation for many years now, and, of course, the cost of health insurance reflects that rise of prices. Why?

    As Dr. Who points out, part of the problem is the insured who don't pay the bill themselves, and therefore don't shop around. However, the insurance companies do shop around and have a list of providers who have agreed to a set price. That set price is somewhere around a half to a third what an uninsured patient will be billed.

    It's a lot easier for an insurance company to shop around than for a patient to do so, especially while nursing a broken leg, or experiencing projectile vomiting.

    The fact that a lot of services are now available that were unheard of a quarter century ago is another factor, one pointed out by Dr Who already. We have a choice: Accept the new procedures and pay the price, or die. That's a no brainer for most of us.

    The uninsured add a huge burden to the care providers, as they often can't pay the bill. Those uninsured tend to wait until they're really sick, then go to the emergency room, the most expensive possible way to go, then don't follow up, and get sick again.

    The pharmaceutical companies add to the problem by inventing brand name drugs, then advertising them until those who don't have a TIVO are ready to puke, just from having seen so many nauseating commercials. That air time is not cheap, and is passed on to the consumer.

    The epidemic of obesity has to be a factor, as obese people require more care than those of normal weight. If everyone went to the gym regularly, our health insurance wouldn't be so expensive.

    The insurance industry is a part of the problem. The overhead for private insurance eats up around 30% of the premium.

    Tort is another factor. Doctors pay big bucks for malpractice insurance, and, of course, those costs have to be passed on to the patient.

    There is no quick fix. At least, we're beginning to hear some ideas from the two presidential candidates, but we're a long way from actually having a plan in place to address the problem. Neither Obama nor McCain's plans are likely to be put into place intact, regardless of who wins the election.

    What we need to see is some rational, non partisan, fact based debate on the issue. What we're likely to see is some simplistic, partisan, non workable plans that increase the profits of whoever has contributed the most to political campaigns.

    I could be wrong about that, of course, but my cynicism tends to be right most of the time.
     
  9. karrma

    karrma New Member

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    Hi Dr. Who,

    I don't know how you cut and pasted my stuff to ask the questions, will address a couple other now.

    A doctor has absolutely no negotiating power over a pharmaceutical company on their costs, other than to write a prescription or not. When there is competition, generics, we can tell them that we are prescribing their competitors medication. Pharmaceutical companies have something called a patent, and they set the market price. Letting patients buy quality medications in Canada or overseas would be a good way to lower the costs of prescriptions, as the foreign countries have negotiated a better price, as does our Federal government program. Insurance companies currently negotiate the price with pharmaceutical companies for their own insured.

    If you have a plan that doesn't pay the prescription, you either pay it or don't.
     
  10. Dr.Who

    Dr.Who Well-Known Member

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  11. Dr.Who

    Dr.Who Well-Known Member

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    I agree that there are multiple reasons some of them legitimate.

    Additionally no or few consumers shop around for insurers either, this choice has also been taken away. So while it is possible that the insurance company has taken over the role of competing for doctors (though I still doubt they do as good a job as millions of consumers could do for themselves as a group) no one is trying to hold down the price of doctors or hold down the price of insurers who does no have a third party (and often conflict of) interest. No one represent the consumer who hold only the consumers interest.
    There is some truth to that. And prior to the days when an employer choose the insurance company then at least prior to the incapacitating event the consumer was free to shop around for an insurance company that he felt would best represent him.

    Agreed. And we also should not complain then when the cost are the result of us wanting new and expensive treatments. The doctor and nurse and hospital do deserve to be paid for their time and investment of capital. I am sure Karrma will agree.
    Agreed. All the more reason to find a reasonable way to keep costs down so people can afford insurance or care, to keep uninsured from other countries from using our system, and to demand that people cannot walk away from their bills.

    If pharmaceutical cos competed against each other then those that wasted funds on advertising would just lose money while others that were more frugal would make money thus weeding out the bad apples and leaving productive companies to survive. But there is a need for copyright laws. So it does seem that if the copyright laws give a company a monopoly on a drug there is justification for gov regulation. After all monopolies are harmful.

    Yep. Perhaps those who don't take care of themselves should join one pool while those who do should join another. Presently, since all the employees of one company belong to the same pool this cannot be done.

    Hmm? I guess companies that have overhead this high should be driven out of business through some mechanism. But what could that be? :) Perhaps they should have to compete against each other in meaningful ways so that unproductive companies go out of business. Because right now employers are not able to force these companies to compete meaningfully and neither does it seem that government is able to either - nor should it.
    Yep that's a problem.

    I share that same cynicism.

    But at least the partisanship is a check on the largest monopoly out there - government.

    I really do fear that universal health insurance would lead to far far fewer checks and balances and far far too much tampering with a complex economic system that no one understands, no one can understand, and that gov will muck up like it does with so many other programs.
     
  12. Dr.Who

    Dr.Who Well-Known Member

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  13. Andy

    Andy Well-Known Member

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    This is an illogical argument. The conservative point of view is antithetical to subsidies.

    Saying subsidies didn't work and therefore conservatism didn't work, is the equivalent to saying cold fusion doesn't work therefore nuclear fission power doesn't work.

    The two are not connected. If anything, subsidies are your idea. Subsidies are the product of the liberal/socialist view point. Isn't it liberals who say we need to subsidize new alternative energy? Or new cures for cancer? Or new social programs?

    Yet they fail constantly, and any conservative who looks at subsidies for anything, including health related, will tell you it will fail. So we don't need to bench conservatism, we need to play it for the first time.

    At least you are willing to admit the socialist based subsidizing doesn't work. We need more of you socialists to realize your position is a failure. I encourage you to do more research on the practical out comes of you view point.
     
  14. GenSeneca

    GenSeneca Well-Known Member

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    He would know this if he bothered to read his own link:

    Mr. Shaman,
    That bitter taste of defeat, is your own foot in your mouth.

    That would be super but the brain dead followers are trained to regurgitate the blame for any policy failure on "Conservatives", even when they had nothing to do with the failed policies.
     
  15. Hobo1

    Hobo1 Active Member

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    I am new here and late to join this tread. However, when I read Dr. Who's initial post (before I read the date of his post), I felt like I could add something new to this conversation.

    I am retired in Indonesia and have no health insurance other than Medicare Part? which allows me to use a US hospital if I return back to the US. The health care system resembles the Wal-Mart analogy, except it goes even further.

    I recently fell off my motorcycle which I shouldn't have been driving so fast in the first place. It goes to prove that the human mind stays young longer than its body! The result was a fracture in the leg bone near my knee. After looking at the X-rays, the doctor said I have three choices.. 1) I could fly to Bali and have orthoscopic surgery which would allow me to walk again in less than a day. The doctor probably would want an MRI first so he could see the situation more clearly, 2) I could have open knee surgery and a wire would be needed to hold the two pieces of broken bone together - I would walk again in a couple days, 3) I could wear a full leg cast for a month and the bone should heal. He said since I was over age 50 and did not stress the knee by playing sports, etc., he recommended #3.

    Hey, I had a choice! Medical care in Indonesia is far less expensive than the US, so I know the cost for the orthoscopic surgery would be less than $10,000 - something that I could afford. However, I decided to go with the leg cast and I rolled around on a wheel chair for a month. When the cast was removed he showed me how to do some physical therapy to strengthen the knee joint. Two months later, I am walking jogging without pain. Total hospital and doctor cost: $150. Used wheel chair: $100. Pain medication: Sold over the counter (no prescription needed): $10.

    There is an example of a health system that is "healthy". I should mention that Indonesia has no laws regarding malpractice so lawyers are not in the equation. Also, virtually nobody has health insurance.

    After the X-rays and initial conversation with the doctor, I was under no obligation to stay. I could have gone to another hospital or clinic and pay only for the X-rays. Also, I could have taken the X-rays to a non-licensed "healer" - who has learned how to repair broken bones from his father and grandfather. He has 20 years experience doing nothing but fixing broken bones so he is far more experienced than any orthopedic surgeon. I learned he would have used two pieces of wood wrapped together like a Mash unit! I would have stayed in a grass hut for 2 weeks, lying on a woven bamboo mat, eating food prepared by his family (rice and vegetables). His cost was "whatever I could pay." If I very poor, I could give him a couple dollars. In my case, he probably would have expected $50 because I was a rich American.

    Look at the lessons: 1) A choice of treatment options with approximate cost known in advance, 2) A hospital with no high tech equipment, 3) No lawyers 4)No health insurance, 5)Low cost, non-licensed practitioners as an available option, and 6) All types of medicine (except opiates) available over the counter [Local drug companies are produce generics with government oversight, ie, cheap. Non-generics made by the patent holding manufacturer are available over the counter, but more expensive.]

    That should give American's some food for thought when we re-work our health care system.
     
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