Health Care Costs....

[Wade Lippman]

I just had a "minor" surgery. They billed $16,000. The insurance company paid $4,500 and I paid $375.

Why do they bill $16,000 when they know they will only get paid a third of that? Sounds like some sort of scam. Anyone know?

[Jim Becker]

That's how things are in the system we have in the US works. Everybody pays a different price depending on what insurance they have (or don't have), whether the services are "in network" and bound to published reimbursement rates from the insurance plan or not, etc. It's extremely complex. And yes, there may very well be someone that actually pays or is expected to pay that sixteen grand, although it would be rare. The system, which is largely for-profit or focused on increased revenue generation if "not-for-profit", is what it is. It's not a scam in the traditional sense, but... Anything I would say beyond that would get into things that we just cannot discuss here and I hope others will avoid that so this thread doesn't disappear.

[Thomas Pender]

Not a fraud. If you do not have private insurance or some form of Medicare/Medicaid, you would have technically been on the hook for the entire 16K because no one would have negotiated or set a lower rate for you. Lots of people get into tough financial shape that way - medical bills cause many bankruptcies. I agree with Jim we are probably better off shying away from this topic.

[Brian Elfert]

Medical providers will often give substantial discounts to those without insurance if you ask.

[Patty Hann]

Medical providers will often give substantial discounts to those without insurance if you ask.
Bingo.
I belong to a Christian Medical Sharing ministry.
They help you negotiate costs.
Example: one member needed knee surgery. Cost was X (I don't remember the exact numbers but it was 5 figures) with Dr Jones at the local hospital.
He found out that if he traveled 50 miles to another hospital the cost was 75% less (yes, you read that right) and the surgeon was..... Dr Jones.

[Bill Dufour]

Our friends sister went to Mexico to get the lap band surgery since her insurance would not cover it. Or maybe the copay was to high, not sure. She saw the doctor on Opra.
Limo picked her up at the airport to the very nice hotel next to the private hospital. Not much more then a luxury cruise for 3-4 day stay.
Mexico now requires a prescription to buy antibiotics. No more stocking up to take home for just in case. I have switched to buying fish antibiotics for my bronchitis. I hear dairies can buy cow medicines. Have not had the bronchitis since covid masking.
Bill D.

[Jim Becker]

Bill, insurance typically doesn't cover those kinds of procedures without someone being able to prove extreme, sometimes "life threatening" medical need.

[Bill Dufour]

My hip replacement list price was like 150,000. Insurance rate paid 13,000. I had about $6,000 after deductible etc.
My wife on medicare had finger surgery, no bill so far.
This outfit is all in one building doctor offices, surgery , physical therapy, medical home care devices like crutches and wheel chairs. All owned by the doctors.
Not sure what happened but my wife's 40 year old hand surgeon just committed suicide. All the doctors are under investigation for insurance fraud. It will be heard to prove which doctor knew and how much.
Bill D

[Bob Borzelleri]

Hospital bill total costs can be mind boggling, but if you really need a reason to scratch your head, go to the line item billings.

My wife’s uncle spent 5 days in a hospital bed for which the Pharmacy line item was $16,000. No unusual or boutique medications that I could find.

Medicare along with his supplement payed all but $450.

[Patty Hann]

Hospital bill total costs can be mind boggling, but if you really need a reason to scratch your head, go to the line item billings.

My wife’s uncle spent 5 days in a hospital bed for which the Pharmacy line item was $16,000. No unusual or boutique medications that I could find.

Medicare along with his supplement payed all but $450.

Someone showed me a line item on his bill: Vicodin....ONE vicodin tablet was $450. (I get 20 of them for $10...thank you Good Rx :) ).

[Edwin Santos]

That's how things are in the system we have in the US works. Everybody pays a different price depending on what insurance they have (or don't have), whether the services are "in network" and bound to published reimbursement rates from the insurance plan or not, etc. It's extremely complex. And yes, there may very well be someone that actually pays or is expected to pay that sixteen grand, although it would be rare. The system, which is largely for-profit or focused on increased revenue generation if "not-for-profit", is what it is. It's not a scam in the traditional sense, but... Anything I would say beyond that would get into things that we just cannot discuss here and I hope others will avoid that so this thread doesn't disappear.

I'm a former hospital Chief Financial Officer. Jim's answer is mostly true. Some of the reason for the high gross charges go back to rules that were associated with the Medicare program decades ago when hospitals were paid in a different manner than they are paid today. The resulting practice was an inflated chargemaster against which discounts called contractual adjustments would be applied with the goal that Medicare is always paying the lower price. Later when managed care came along, the game became negotiated discounts, so hospitals raised their charges in response i.e. instead of charging you $200, I'll charge you $400 but give you a 50% discount, or $2000 and a 90% discount. I know, it sounds absurd but at this point, it's an entrenched practice.
Imagine the difference between a building that was built to a cohesive, elegant design from scratch versus a building that started out one way and then had renovation after renovation bolted on until it looked like an absolute hodgepodge. The latter is our healthcare system.

As Jim says, most people are covered by some type of insurance and hence pay a small fraction of billed charges based on the negotiated rate. The problem becomes the significant number of Americans who have no coverage. Those people are billed the full charges, and many are driven into bankruptcy as a result of the collections process.
It might seem like hospital corporations are greedy (and many are) but if they do not follow their chargemaster, it can have a cascading effect on all the other reimbursement that is built on it, including Medicare and Medicaid.
This said, there are various ways a hospital can always work with people including charity care mechanisms.
But the fact remains that purchasing power and other kinds of influence drive most of health care's economics, and sadly, the individual patient has no leverage so the patient is usually the caboose on the train and will have to go wherever the train takes him/her.

This is a very crude and brief summary, but it gives you the gist of it. Don't get me started on pharmaceutical pricing, regulated (in some states) ambulance pricing, unionization, and Rubik's cube of regulatory rules.

My advice to all, especially young people - take an active interest in your health. Do so at any point, but earlier in life the better. Simple lifestyle practices can eliminate a large percentage of chronic disease. Be your own advocate because the system we have is a reactive health care system, not wired toward prevention. So you have to be your own preventive health coach.

EDIT: My post is intended to be a technical post about hospital accounting and industry reimbursement. I hope the info is useful, at least in the course of understanding one aspect of a complicated system. I hope the rest of the thread does not devolve, and cause the whole thing to be deleted because sometimes useful info gets thrown out with the bathwater.

[Edwin Santos]

Someone showed me a line item on his bill: Vicodin....ONE vicodin tablet was $450. (I get 20 of them for $10...thank you Good Rx :) ).

GoodRX effectively got you a discount of 97.8% versus that particular hospital's chargemaster. In reality the Average Wholesale Price they pay for Vicodin is much much less.
Either way, you're getting the benefit of GoodRx's purchasing power as an extension to a middleman called a Pharmacy Benefits Manager (PBM). In this way, you gained leverage that you would not have had as a single patient. Good work.

EDIT: A lot of people wonder how GoodRx makes any money extending these discounts. They mostly get rebates from wholesalers and sometimes the manufacturers themselves. In your case it wouldn't be much but imagine millions of patients with multiple prescriptions. Personally I see it as a win-win and a good consumer resource.

[Ron Citerone]

Thanks Edwin! Hope this isn’t deleted. I like when people with work knowledge share on this site. Adds real perspective you can’t always get elsewhere.
BTW, is it true that a person without insurance can ask to be charged the rate of the most frequent user of a service? Usually Medicare..

[Patty Hann]

Thanks Edwin! Hope this isn’t deleted. I like when people with work knowledge share on this site. Adds real perspective you can’t always get elsewhere.
BTW, is it true that a person without insurance can ask to be charged the rate of the most frequent user of a service? Usually Medicare..
No harm in asking :)...ever.

In the medical realm I'm in (let's keep it nameless) one of the first things you are taught is how to ask for discounts.
And medicare rates are often the baseline for the discounted price.
Sometimes you can get that rate, and sometimes it's a bit higher.

[Jerry Bruette]

I'm a former hospital Chief Financial Officer. Jim's answer is mostly true. Some of the reason for the high gross charges go back to rules that were associated with the Medicare program decades ago when hospitals were paid in a different manner than they are paid today. The resulting practice was an inflated chargemaster against which discounts called contractual adjustments would be applied with the goal that Medicare is always paying the lower price. Later when managed care came along, the game became negotiated discounts, so hospitals raised their charges in response i.e. instead of charging you $200, I'll charge you $400 but give you a 50% discount, or $2000 and a 90% discount. I know, it sounds absurd but at this point, it's an entrenched practice.
Imagine the difference between a building that was built to a cohesive, elegant design from scratch versus a building that started out one way and then had renovation after renovation bolted on until it looked like an absolute hodgepodge. The latter is our healthcare system.

So how do we get out of this hellish cycle? I use a CPAP nightly and won't run any of my equipment or machines through insurance. The providers jack the price up 400% then submit it to my insurance company and I end up paying more with the insurance deductible than the advertised price on a suppliers website.

[Larry Frank]

I do not even want to think how much I have cost insurance..Medicare with supplement. With significant back surgeries, it must be huge.

Now, my left hip needs to be redone. It has lasted over 20 years but parts are loose.

[Bruce Wrenn]

A few years back, heart patients without insurance were going to India for procedures. Total cost, including airfare for both patient,and another were less than 1/4 costs in US. In Dec 2021, I had a heart attack. Total bill before insurance buy downs was over $150,000. After buy downs, my share was around $450. One thing hospitals here do, and most likely elsewhere, is put Medicare patient in hospital under observation, not admitted. This way if patient shows back up in three days after discharge, hospital doesn't take a reduction from Medicare. This creates a hardship on patient if they need to go to rehab, as Medicare only pays if you were hospitalized for three days. Always ask, am I admitted, or under observation? What is done for patient is the same in either case, but it's a CYA for hospital

[Alan Rutherford]

The Commonwealth Fund (https://www.commonwealthfund.org/) has a lot of data about comparative costs and outcomes in many countries. Spending on healthcare in the US has grown disproportionately compared to other high-income countries. Quality of care in most areas is either no better than, or not as good as, the other countries.
497090

[Bob Borzelleri]

Healthcare in the US is like many other systems (energy, land use planning, water rights and usage) that have morphed over many decades. The thing they all have in common is the answer to the question, “If you were starting from scratch, is this the system you would build?”

And that answer, in most cases, is an emphatic no.

[Kev Williams]

My wife had a subacrachnoid brain hemorrhage a few years ago, spent the morning in the ER of one hospital getting several brain scans and enough pain killers pumped into her veins to float a battleship. Hospital #1 didn't have the necessary equipment to treat her so an ambulance took her to hospital #2. She spent 11 days there in ICU getting many scans and angiograms, and 2 more days in recovery. After all that time they never found the source of the bleed. They presented us with a bill for just shy of $115k. The ER trip was just shy of $20k. Our total out of pocket -- the ER at #1, ambulance ride and 13 days at #2-- was $1830.00. I was expecting well into the $20-$30k range out of pocket, so we were pretty elated about our Medicare plus a Humana kicker insurance coverage!

--For about 15 minutes...

As we were finally checking out of hospital #2, they had us sign a statement, agreeing that we understood that if her problem re-appeared anytime in the future, her insurance coverage was persona non grata at their hospital and she would be welcome ONLY if willing to pay 100% out of pocket.

So, that ordeal aside, we're still happy with our medical coverage. But alas, IMHO, it seems that NO Virginia, there ain't no Santa Claus...

[Patty Hann]

My wife had a subacrachnoid brain hemorrhage a few years ago, spent the morning in the ER of one hospital getting several brain scans and enough pain killers pumped into her veins to float a battleship. Hospital #1 didn't have the necessary equipment to treat her so an ambulance took her to hospital #2. She spent 11 days there in ICU getting many scans and angiograms, and 2 more days in recovery. After all that time they never found the source of the bleed. They presented us with a bill for just shy of $115k. The ER trip was just shy of $20k. Our total out of pocket -- the ER at #1, ambulance ride and 13 days at #2-- was $1830.00. I was expecting well into the $20-$30k range out of pocket, so we were pretty elated about our Medicare plus a Humana kicker insurance coverage!

--For about 15 minutes...

As we were finally checking out of hospital #2, they had us sign a statement, agreeing that we understood that if her problem re-appeared anytime in the future, her insurance coverage was persona non grata at their hospital and she would be welcome ONLY if willing to pay 100% out of pocket.

So, that ordeal aside, we're still happy with our medical coverage. But alas, IMHO, it seems that NO Virginia, there ain't no Santa Claus...
I don't understand....
If you have medicare and the medigap supplement (Humana) how can a hospital refuse you service?
Medicare A pays for hospital visits if the person is admitted. Period. (Or so I thought :confused:)

[Brian Elfert]

I don't understand....
If you have medicare and the medigap supplement (Humana) how can a hospital refuse you service?
Medicare A pays for hospital visits if the person is admitted. Period. (Or so I thought :confused:)

Doesn't Medicare have some sort of thing now where if a patient gets readmitted for the same thing within a certain period of time that the medical provider gets no additional money? That might explain why a hospital would say not to come back unless you are willing to pay out of pocket.

[Edwin Santos]

Doesn't Medicare have some sort of thing now where if a patient gets readmitted for the same thing within a certain period of time that the medical provider gets no additional money? That might explain why a hospital would say not to come back unless you are willing to pay out of pocket.

Yes, readmit penalties were initiated in 2013 for certain patient types. But they should not result in a limitation of benefits to the patient, the only effect should be on the hospital. The thought process behind them is to penalize a hospital for discharging a patient too early (which many times is in their financial interest to do). The penalty is on the first hospital that provided care in the episode of illness, and it applies even if the patient is readmitted to a completely different hospital. IMO the readmit penalties are a good mechanism for quality of patient care because premature discharge is a serious safety issue.

I don't fully understand the story about hospital #2 telling the patient they weren't welcome back unless paying out of pocket.
Best I can tell, it sounds like an out of network issue. When beneficiaries sign on to Medicare Advantage plans, often times, they are limited to that plan's provider network, at least for non-emergent care, not to mention other limitations.
If this was a traditional Medicare (non-Advantage) patient, then I don't understand why they would say that.

One thing you can count on - if there is any opportunity for an insurance company to deny a claim, they (their software) will.
If it is a hospital that is part of a large system that the insurer cannot live without in a given market, then they'll duke it out on the denied claims but ultimately pay them. If it is a smaller independent hospital that doesn't have that kind of leverage, then that hospital will probably have to take the hit.
This is why there is so much consolidation in the industry and so few independent hospitals. Survival of the biggest. You will find most major metropolitan markets have one or two dominant hospital systems for this reason.

[Patty Hann]

...

One thing you can count on - if there is any opportunity for an insurance company to deny a claim, they (their software) will.
If it is a hospital that is part of a large system that the insurer cannot live without in a given market, then they'll duke it out on the denied claims but ultimately pay them. If it is a smaller independent hospital that doesn't have that kind of leverage, then that hospital will probably have to take the hit.
This is why there is so much consolidation in the industry and so few independent hospitals. Survival of the biggest. You will find most major metropolitan markets have one or two dominant hospital systems for this reason.


Fascinating info....thank you Mr Santos for taking the time to explain how all this works (or why it might not work).

[Curt Harms]

The problem becomes the significant number of Americans who have no coverage. Those people are billed the full charges, and many are driven into bankruptcy as a result of the collections process.

I for one thought that problem was addressed in 2010.

[Jim Becker]

While the number of folks in the US that have health insurance is substantially higher today, there is still a very large number of people who do not have coverage. Any further comment on my part about that would not be permitted here. ;)

[Edwin Santos]

I for one thought that problem was addressed in 2010.

It was addressed, and the situation was significantly improved insofar as access to insurance was improved, especially for those with pre-existing conditions. But it's still a private system in the sense that the insurers in the health exchanges are still private companies that have to attach a price to coverage. Some tiers are more affordable than others based on the benefit/premium mix. The problem of affordability still keeps many people out.
ACA was insurance reform, not health care reform. So as the underlying costs continue to escalate at a rapid rate, and the premiums escalate along with them.

Don't get me wrong, ACA took a bad situation and made it less bad, and it has been a positive game changer for many people.

[Edwin Santos]

Fascinating info....thank you Mr Santos for taking the time to explain how all this works (or why it might not work).

Patty, I notice you live in Arizona, and so do I. You will understand when I say it is simply not possible for any insurer to have a complete network without Banner Health. So guess who has the leverage in a contract negotiation? The insurer will have to pay the piper, and then make it up in the premiums. If the insurer refuses to play ball and walks away, their commercial business will quickly dry up because employer HR departments will howl at the idea that Banner is no longer in-network and they'll cancel coverage, take their group elsewhere.

So when a small (or not so small) employer comes up for renewal and learns their premiums are going up by 40%, often times it is by product of the contract negotiation between their insurer and indispensable (dare I say monopoly) providers, although there can be other contributing factors too.

Could you imagine running a millwork shop or contractor business where you didn't have to care about your costs because you could charge pretty much whatever you want, and if your customer didn't pay it, they would be harming their own business?

BTW, Banner is an excellent provider. I just use them as an example of market leverage and how it affects health care cost for the whole system. And I picked a hospital system, but just as easily could have picked an insurance company, ancillary service provider, medical device manufacturer or pharmaceutical company.

[Patty Hann]

Patty, I notice you live in Arizona, and so do I. You will understand when I say it is simply not possible for any insurer to have a complete network without Banner Health. So guess who has the leverage in a contract negotiation? The insurer will have to pay the piper, and then make it up in the premiums. If the insurer refuses to play ball and walks away, their commercial business will quickly dry up because employer HR departments will howl at the idea that Banner is no longer in-network and they'll cancel coverage, take their group elsewhere.

So when a small (or not so small) employer comes up for renewal and learns their premiums are going up by 40%, often times it is by product of the contract negotiation between their insurer and indispensable (dare I say monopoly) providers, although there can be other contributing factors too.

Could you imagine running a millwork shop or contractor business where you didn't have to care about your costs because you could charge pretty much whatever you want, and if your customer didn't pay it, they would be harming their own business?

BTW, Banner is an excellent provider. I just use them as an example of market leverage and how it affects health care cost for the whole system. And I picked a hospital system, but just as easily could have picked an insurance company, ancillary service provider, medical device manufacturer or pharmaceutical company.
Yep, Banner, Osborne, Mercy (Don't know if I've got the affiliations right) but, yep....used them all at one time or another (not Mayo, tho').
ANd now I'm on Medicare so I can use most any of them with no restrictions.

[Stan Calow]

The other day I read that the average monthly premiums for medical insurance in the US was about $1000. Thats twelve thousand a year and you can wonder how sustainable that is.

[Patty Hann]

The other day I read that the average monthly premiums for medical insurance in the US was about $1000. Thats twelve thousand a year and you can wonder how sustainable that is.

So $12000 per annum premium....but don't forget about that pesky out-of-pocket/deductible.
A lot of folks/families won't see that $12000 "used" until they've paid out of pocket , oh, I'm guessing at least $10,000.
Meaning they have to [potentially] spend $22K before the insurance pays out especially if no expensive medical need arises until the last month or two of the calendar year.

[Brian Elfert]

We have a new healthcare plan choice at work. It costs less than our other option, but has no deductible. The trick is that you pay a co-pay for every visit. The co-pay varies among providers. It is strange how the co-pays are set. There can be a dozen family practice doctors at a clinic, but there might be a half dozen different co-pays depending on who you see. I expect the clinic gets the same payment for a family practice visit from the insurance company no matter which doctor I see.

An interesting thing is the co-pay covers all services during a visit. If I see my family doctor and need lab tests and x-rays during that visit the x-rays and lab tests are covered by the one co-pay. The same thing for an ER visit. I also pay a single co-pay for an ER visit no matter how many procedures, tests, and imaging I need while in the ER. It isn't really clear what happens if you need emergency surgery.

[Mark Rainey]

My advice to all, especially young people - take an active interest in your health. Do so at any point, but earlier in life the better. Simple lifestyle practices can eliminate a large percentage of chronic disease. Be your own advocate because the system we have is a reactive health care system, not wired toward prevention. So you have to be your own preventive health coach.


Good advice. And as a physician, my advice to old people ( like me ) is to be aware that overmedicalization is a major problem today. Prednisone dose packs and antibiotics are handed out like candy. CT scans and MRI scans for back pain don't cure the back pain but do generate revenue. We are experiencing the medicalization of aging. Be an educated consumer. There are several resources that are helpful (https://www.amazon.com/Last-Well-Person-Despite-Health-Care/dp/0773527958/ref=sr_1_1?gclid=EAIaIQobChMI97W9u__O_QIVhgqtBh1yJ wOqEAAYASAAEgJoTvD_BwE&hvadid=241614356053&hvdev=c&hvlocphy=9007106&hvnetw=g&hvqmt=e&hvrand=9278724946824360221&hvtargid=kwd-794340575&hydadcr=9800_10377163&keywords=the+last+well+person&qid=1678369999&sr=8-1)

[Brian Elfert]

Good advice. And as a physician, my advice to old people ( like me ) is to be aware that overmedicalization is a major problem today. Prednisone dose packs and antibiotics are handed out like candy. CT scans and MRI scans for back pain don't cure the back pain but do generate revenue. We are experiencing the medicalization of aging. Be an educated consumer. There are several resources that are helpful (https://www.amazon.com/Last-Well-Person-Despite-Health-Care/dp/0773527958/ref=sr_1_1?gclid=EAIaIQobChMI97W9u__O_QIVhgqtBh1yJ wOqEAAYASAAEgJoTvD_BwE&hvadid=241614356053&hvdev=c&hvlocphy=9007106&hvnetw=g&hvqmt=e&hvrand=9278724946824360221&hvtargid=kwd-794340575&hydadcr=9800_10377163&keywords=the+last+well+person&qid=1678369999&sr=8-1)

Isn't the reason for an MRI or CT scan of the back to see if there are structural issues that might require surgery or other intervention versus a simple muscular issue? I have lower back issues, but my issues are definitely muscular from lack of physical activity and lack of exercise. I am currently doing daily exercises to strengthen my lower backer and hip muscles.

[Mark Rainey]

Isn't the reason for an MRI or CT scan of the back to see if there are structural issues that might require surgery or other intervention versus a simple muscular issue? I have lower back issues, but my issues are definitely muscular from lack of physical activity and lack of exercise. I am currently doing daily exercises to strengthen my lower backer and hip muscles.

Back pain is VERY common. Most of us will be afflicted with back pain at one time or another in our life. Usually we cope, and it passes. When it does not pass, see your doctor. If there are warning signals that something serious is going on, they may order imaging. If they do not think something serious is going on, they will not order tests. Do not push them into testing. It can be useless or even harmful. Most back pain will resolve without surgery and findings on MRI scan frequently have no relationship to your pain. The information must be carefully reviewed and a treatment plan developed. I believe 20 years ago they had 10 MRI scanners in Canada, and 2,000 here. And yet the Canadians have no more back disability than we did. The most famous back surgeon Gordon Waddell MD stated the most common cause of low back disability is physicians. Stay active, stay strong during tough times, look at books for lay people by brilliant physicians who are dedicated to serving their patients ( and not big bucks ) like Dr Nortin Hadler ( Harvard trained ) and Dr Gilbert Welch ( author of Overdiagnosed: Making People Sick in the Pursuit of Health )

[Edwin Santos]

Good advice. And as a physician, my advice to old people ( like me ) is to be aware that overmedicalization is a major problem today. Prednisone dose packs and antibiotics are handed out like candy. CT scans and MRI scans for back pain don't cure the back pain but do generate revenue. We are experiencing the medicalization of aging. Be an educated consumer. There are several resources that are helpful (https://www.amazon.com/Last-Well-Person-Despite-Health-Care/dp/0773527958/ref=sr_1_1?gclid=EAIaIQobChMI97W9u__O_QIVhgqtBh1yJ wOqEAAYASAAEgJoTvD_BwE&hvadid=241614356053&hvdev=c&hvlocphy=9007106&hvnetw=g&hvqmt=e&hvrand=9278724946824360221&hvtargid=kwd-794340575&hydadcr=9800_10377163&keywords=the+last+well+person&qid=1678369999&sr=8-1)

I appreciate this warning to be attentive to overmedicalization. I had a long conversation about this with a medical director in the hospital where I worked. His position was that defensive medicine was influencing a large % of medication orders. In other words, if a physician were sued, failure to meet standard of care is often failure to order a medication or test, rarely (if ever) ordering too much.
So when a physician is under time pressure to see as a large daily caseload of patients, the safest path of legal risk management is to err to the side of over medicating and over testing. Works out very well for drug and diagnostic companies that the legal system helps drive volume.

We brought in a consultant to help design the formulary for our P&T committee. He was a decorated research Pharm D who lectured all over the country. His position was that the extent of drug interactions was always a wild variable. It's simply not possible to run trials on every combination of drugs and underlying medical conditions, so with each additional medication, the potential for interaction problems went up too, and exponentially at that. Another argument for limiting medications to only those that are absolutely necessary.

[Jim Becker]

The overmedication thing is very real, especially for, um...more mature...patients who tend to see more providers for their healthcare, especially when they are picking and choosing their providers a la carté rather than being in a local 'system' with a primary care doctor "directing traffic". Medicare patients, for example. I actually caught and issue around this with my mother when she was still alive. This kind of situation is ripe for both incompatibilities as well as larger doses of certain compounds that might be an ingredient in something else. That can be anything between uncomfortable all the way to deadly. Professor Dr. SWMBO and I are fortunate in this respect that we've been working with a primary practice that's associated with the local hospital system and most specialists we see are also associated. That means they all are looking at the same medical records, regardless of their particular practice and reduces the chance of issues with medication incompatibilities or amounts in excess of need. We intend to continue working with these same folks as The Professor transitions into retirement this year, regardless of our insurance coverage elections outside of not choosing anything that would preclude using the provider group, without going into details since they are not determined yet.

[Bill Dufour]

The claim is that something like 25% of the medical employes are just involved with insurance. A doctors office will have one or two employees whose only job is figuring out how to bill the insurance companies and for what.
Years ago I read of one insurance company who decided to no longer require prior authorization for patients to see specialists or take special tests. They found the cost of multiple visits to get the pre authorizations cost more then the money saved by denying some few cases. I would suppose less costly treatments if diagnosed sooner.
Bill D.

[Jim Becker]

Bill, that's one reason so many smaller medical practices have sold out to large firms and became "employees" of the same...not having to deal with the insurance processing anymore and just taking a salary. This is not just individual physicians, but whole practices with multiple MDs, DOs, PAs, NPs, etc. The folks at the desk only handle appointments and insuring that the proper insurance information is in the computer. All the processing is dealt with by the larger multiple practice owner.

[Alan Rutherford]

On January 30, 2023 the Journal of the American Medical Association published an opinion piece titled "The Existential Threat of Greed in US Health Care" which makes the claim that financial self-interest in US health care is becoming a stranglehold, with "dangerous and pervasive consequences".

[Mark Rainey]

On January 30, 2023 the Journal of the American Medical Association published an opinion piece titled "The Existential Threat of Greed in US Health Care" which makes the claim that financial self-interest in US health care is becoming a stranglehold, with "dangerous and pervasive consequences".

Very true.

[Doug Garson]

Wow, the more I read the posts in this thread, the more I appreciate our Canadian universal health care system despite all its faults.

[Bob Borzelleri]

On January 30, 2023 the Journal of the American Medical Association published an opinion piece titled "The Existential Threat of Greed in US Health Care" which makes the claim that financial self-interest in US health care is becoming a stranglehold, with "dangerous and pervasive consequences".

And, if we were starting from scratch in designing a health care system that provides equal access to quality health care services in the US, is the current system what we would strive for? Not by a long shot.

[Brian Elfert]

I appreciate this warning to be attentive to overmedicalization. I had a long conversation about this with a medical director in the hospital where I worked. His position was that defensive medicine was influencing a large % of medication orders. In other words, if a physician were sued, failure to meet standard of care is often failure to order a medication or test, rarely (if ever) ordering too much.
So when a physician is under time pressure to see as a large daily caseload of patients, the safest path of legal risk management is to err to the side of over medicating and over testing. Works out very well for drug and diagnostic companies that the legal system helps drive volume.


Exactly. Doctors and other medical professionals are so scared of getting sued for missing some illness/condition that they order all sorts of diagnostic tests just in case. Patients are not helping here either. Patients often want diagnostic tests because it feels like something is being done to help them. Patients with medical insurance don't care about the cost of the tests because it costs them little or nothing at the time of the tests. Never mind that it drives up the cost of their health insurance.

[Tim Elett]

If we could use money from a retirement account without penalty for medical expenses or dental would be nice.

[Perry Hilbert Jr]

Years ago, I worked for a company that was going through a near bankruptcy. There wqas a big pay out coming down the road, and many of us hung in there and did get the big bonus, but there were a few months when we weren't sure about getting a weekly pay check and twice the company missed health insurance payments. What was odd, was that my step son's asthma medicine with the prescription coverage had a co-pay of $15.00. When the insurance coverage was canceled and we needed a refill, the cost was $10.39 without insurance. So from then on for some rx's we told the pharmacy we didn't have insurance and got a lower price. On the other hand, my dentist of 25 years just stopped taking my dental coverage. Dentist told me ahead of time that the insurance simply refused to pay enough for them to pay the bills and the negotiator for the dental insurance told them to "increase the prices to uninsured people to make up the difference." Our dental insurance was through one of the largest employers in the county, all the local dentists refused to continue taking it, so some 9,000 families lost their dentists and can't find new ones that take their insurance.

[David Publicover]

Wow, the more I read the posts in this thread, the more I appreciate our Canadian universal health care system despite all its faults.

I’m with you Doug. Wow indeed!

[Rich Engelhardt]

I've been saying that ever since the 1980s that the medical industry is using people as a cash crop. Yeah it's a bit more crude than the polite way it's being said in this thread, but, it's not a tiny bit less accurate.


I'll tell you a 100% sure fire way to get rid of 99% of all those sore backs the industry is exploiting.

Get rid of the big belly and the back will be fine.

[Stan Calow]

As someone once told me, health care in the US is a business helping you live long enough to get as much of your money as they can.

[Dave Zellers]

Get rid of the big belly and the back will be fine.

Ha! Big belly and big pharma. :p

[Jeff Clode]

I’ve been following comments here with interest. I am a retired physician (internist) with a long standing interest in medical economics. I realize we can’t get into the political arena and it’s not my intent to do so but I would recommend two books for those interested in the evolution of our current system and a comparison between ours and other systems around the world. The first is “Power, Politics, and Universal Health Care” by Stuart Altman and the second is “The Healing of America” by TR Reid. Altman covers the history of governmental involvement in US healthcare and probably know more about it than anyone. It’s a bit of a long book but worth it for anyone truly interested in health care in the US. Reid is a reporter who compares heath care delivery in major economies around the world and examines strengths and weakness in all - I think pretty objectively. Both books about 10+ years old but still relevant. Read ‘em and you will know more than 99% of folks talking about the subject.
Jeff

[Jim Koepke]

I've been saying that ever since the 1980s that the medical industry is using people as a cash crop.

My recollection is that the '80s was when a lot of medical providers switched from nonprofit organizations to for profit businesses.

After reading a lot of the posts here I'm glad my medical provider stayed a nonprofit.

jtk

[Edwin Santos]

I’ve been following comments here with interest. I am a retired physician (internist) with a long standing interest in medical economics. I realize we can’t get into the political arena and it’s not my intent to do so but I would recommend two books for those interested in the evolution of our current system and a comparison between ours and other systems around the world. The first is “Power, Politics, and Universal Health Care” by Stuart Altman and the second is “The Healing of America” by TR Reid. Altman covers the history of governmental involvement in US healthcare and probably know more about it than anyone. It’s a bit of a long book but worth it for anyone truly interested in health care in the US. Reid is a reporter who compares heath care delivery in major economies around the world and examines strengths and weakness in all - I think pretty objectively. Both books about 10+ years old but still relevant. Read ‘em and you will know more than 99% of folks talking about the subject.
Jeff

For anyone interested, TR Reid did a one hour documentary for Frontline called Sick Around the World which preceded his book by a couple of years. He chronicles health systems in several countries. I thought it was very good.
Being a finance/accounting person by background, I was especially impressed by the analytical methods the Japanese used for price setting and also how the private industry found innovative ways to comply with the set pricing by developing more efficient medical devices. For example, the price the Japanese set for an MRI was a fraction of what is conventional in the US. In response Samsung developed a more efficient but equally effective MRI scanner that made the fee payment workable.

It was also memorable to me that the NHS in the UK built in mechanisms to incentivize family physicians for providing preventive care and health counseling. If you like the documentary, then you can be sure you'll love the book.

https://www.pbs.org/wgbh/frontline/documentary/sickaroundtheworld/

[Paul Wunder]

An eye opener for me re US vs Foreign medical costs:

Five years ago I was a tourist in Jerusalem, Israel and unfortunately became ill and had to be hospitalized. I was taken to Hadassah Hospital in Jerusalem by ambulance. I was treated in the ER and was admitted for three days. Multiple blood tests, IV's, CT scans and other procedures. I was given a private room in the 800 bed teaching hospital and received excellent care. I am a US citizen by birth.

I was billed as follows: Ambulance $100; ER plus three hospital days $2400.

When I returned home home my Medicare Supplemental Plan paid 80% of my costs. A single ER visit in the US can result in a patient bill for many times he amount of my Israeli bill. Surely the US can find a better way.

[Rod Sheridan]

It is a learning opportunity which I find very interesting……Regards, Rod