Healthcare costs -- the Brill article

[meazza]

well if you want to point to someone who misinterpreted the article, how bout meazza? he thinks it's about rich and poor getting different levels of care. i guess that's because the patient that went to texas for cancer care chose a "cadillac" option for care. first of all, that wasn't brill's point. secondly, the cost wouldn't likely have been much lower at podunk community hospital. THAT was the point i believe brill was making.. and the idea that everyone gets equal care regardless of ability to pay is a strawman. i didn't read brill nor have i read any mainstream proponents of universal coverage demanding it. most want chevy levels of care for everyone. if you want more bells and whistles and can afford it, that's fine. to me those are the profit sources that are most appropriate for exploitation if we continue to insist on a for profit system.

 

I didn't say the article was specifically about that or the point the author was trying to make but it is often the type of example that would be used in the single payer vs insurance debate.

 

After all the times on this forum that you've totally missed the point, you shouldn't be throwing stones.

[Alaska Darin]

ok. i agree this article didn't support single payer or the aca as the solution. it wasn't really about solutions. it illuminated the problems, which are many. there is no single solution but for problems so deep i believe fundamental change is required. that's not what many folks are proposing. they believe the market place can solve these issues. i believe the free market in health care is much of the problem. buying and selling care for a heart attack isn't in any way similar to buying a big screen tv or car. and that truth is well illustrated in this piece.

There isn't anything "free market" about the American health care "system".

[birdog1960]

There isn't anything "free market" about the American health care "system".

There isn't anything "free market" about the American health care "system".

watching recorded meet the press and fast forwarded through an ad for stryker knee replacements. so let me get this right - firstly, this is meant to encourage folks to go to their doctor and demand a knee replacement. then to demand from the orthopedist a particular brand. will you accept "profit driven" in place of free market?

[Alaska Darin]

watching recorded meet the press and fast forwarded through an ad for stryker knee replacements. so let me get this right - firstly, this is meant to encourage folks to go to their doctor and demand a knee replacement. then to demand from the orthopedist a particular brand. will you accept "profit driven" in place of free market?

You don't have to explain the role of advertising - it's the reason I rarely watch live television. The American health care "system" has facets of the free market but it's probably the best/worst example of government intervention into the free market. The balance is shot all to hell. I'd say it's a long range conspiracy by the bureaucrats to effect a takeover but there's no way they're competent/smart enough to pull that off over such an extended term.

[TakeYouToTasker]

the laws against the kind of crap the scooter store has done for years are in place. they haven't been properly used. who do i blame? i'd bet that the folks at the scooter store have some friends in high places.... does that make the entire medicare system a failure? do i have patients with legitimate needs for a scooter? have i complained to medicare in the past about the scooter store? no. yes. yes.

 

so what's the answer? take away the incentive... lower profit margins for mobility devices or open the business to bids. i'm sure an actuary could estimate approximately how many scooters should be truly needed per 1000 medicare recipients. pay an amount proportional to that number of patient at reasonable profit. have certified examiners determine need. and while they're at it, open bidding for prescription drugs for a national formulary.

Oh, good grief...

 

I get less than half-way down page one, and someone has already suggested creating a "Ministry of Scooters"...

 

Does the thread get any better, or is this the kind of stupidity I'll subject myself to for the duration of my reading should I continue?

[birdog1960]

You don't have to explain the role of advertising - it's the reason I rarely watch live television. The American health care "system" has facets of the free market but it's probably the best/worst example of government intervention into the free market. The balance is shot all to hell. I'd say it's a long range conspiracy by the bureaucrats to effect a takeover but there's no way they're competent/smart enough to pull that off over such an extended term.

didn't intend to be patronizing...just pointing out that this type of thing is so common here that, as bizarre as it is, we tend to accept it as normal.

 

Oh, good grief...

 

I get less than half-way down page one, and someone has already suggested creating a "Ministry of Scooters"...

 

Does the thread get any better, or is this the kind of stupidity I'll subject myself to for the duration of my reading should I continue?

oh, please...estimating how many qualified candidates exist and paying a private company to provide scooters to those recipients for a set fee would require very little in resources while saving huge sums. certified would mean doctors tested on requirements and then providing exams for people that were not their patients. this is just common sense yet you dismiss it out of hand. have a lot of experience in the area, do ya?

[TPS]

 

You don't have to explain the role of advertising - it's the reason I rarely watch live television. The American health care "system" has facets of the free market but it's probably the best/worst example of government intervention into the free market. The balance is shot all to hell. I'd say it's a long range conspiracy by the bureaucrats to effect a takeover but there's no way they're competent/smart enough to pull that off over such an extended term.

I just ordered a book that I found out about from a book review in the latest New Yorker. The review references two similar books, one by Bruno Rizzi published in 1939 called the "Bureaucratization of the World," and the other by James Burnham published in 1941 called "The Managerial Revolution." Both authors argued that the world would eventually be taken over by major powers ruled by entrenched bureaucracies that cared little for the populous. I ordered the Burnham book, as it says Orwell's "1984" was influenced by this one. JK Galbraith also acknowledges this book as influencing his "The INdustrial State." A quote of Burnham's book from the review, "The economies of the major powers had fallen into the hands of a new elite: the managers, executives,financiers, and stockholders who owned and ran corporations, and the government administrators who regulated them." Doesn't sound to far off...

[Meathead]

thats already happened. theyre called republicans

[Nanker]

thats already happened. theyre called republicans government bureaucrats.

 

Fixed it for you.

 

Birdbrain is right though about the providers of medical care being on the plus side of adding more services than what are necessary. Take the mammogram for example. I believe it was just last year, studies showed women were getting too many breast x-rays, and that they were counterproductive. Another "value add" that Dentists love is the routine x-ray of healthy teeth. "Hey - your insurance covers it." I've been told for the past two years as I've had to sign a waiver at each semi-annual routine teeth cleaning appointment, because I don't want my skull irradiated. His new Mercedes payment, be damned.

 

I can't help but marvel though at the docs that are aligned with the single payer option and crow that its more efficient and they will get the providers to accept less for their services. Their services... THEIR services. I thought that was one of the problems. Medicare & Medicaid paying 10¢ on the dollar for THEIR services to such an extent that the ranks of future generations of medical care providers would be filled - not by some of the best and brightest - but by others who more traditionally work in such lower paying professions.

 

By the way, I love how the evil insurance megaliths bent on making profit at the expense of the patient are actually the ones doing the back office work for Medicare.

[birdog1960]

Fixed it for you.

 

Birdbrain is right though about the providers of medical care being on the plus side of adding more services than what are necessary. Take the mammogram for example. I believe it was just last year, studies showed women were getting too many breast x-rays, and that they were counterproductive. Another "value add" that Dentists love is the routine x-ray of healthy teeth. "Hey - your insurance covers it." I've been told for the past two years as I've had to sign a waiver at each semi-annual routine teeth cleaning appointment, because I don't want my skull irradiated. His new Mercedes payment, be damned.

 

I can't help but marvel though at the docs that are aligned with the single payer option and crow that its more efficient and they will get the providers to accept less for their services. Their services... THEIR services. I thought that was one of the problems. Medicare & Medicaid paying 10¢ on the dollar for THEIR services to such an extent that the ranks of future generations of medical care providers would be filled - not by some of the best and brightest - but by others who more traditionally work in such lower paying professions.

 

By the way, I love how the evil insurance megaliths bent on making profit at the expense of the patient are actually the ones doing the back office work for Medicare.

you really think physician supporters of single payer don't understand that payments to doctors will decrease under such a plan? this argument that the quality of applicant will suffer has no basis in fact . we've been through this before and have seen applicant rates to med school in single payer countries face even more competition than in our for profit system. the fact is that in most single payer countries, docs are still relatively high earners and medicine is still a respected and honored calling.

 

as to your last statement, so...? if it's less expensive to farm out clerical, billing, coding and payment functions to a 3rd party then they should do that. but with single payer, this all gets much less complicated. one process across the system for all these functions and consequently the need for less people to do them

[TakeYouToTasker]

oh, please...estimating how many qualified candidates exist and paying a private company to provide scooters to those recipients for a set fee would require very little in resources while saving huge sums. certified would mean doctors tested on requirements and then providing exams for people that were not their patients. this is just common sense yet you dismiss it out of hand. have a lot of experience in the area, do ya?

Right....

 

So "Ministry of Scooters" it is then?

[Doc]

you really think physician supporters of single payer don't understand that payments to doctors will decrease under such a plan? this argument that the quality of applicant will suffer has no basis in fact . we've been through this before and have seen applicant rates to med school in single payer countries face even more competition than in our for profit system. the fact is that in most single payer countries, docs are still relatively high earners and medicine is still a respected and honored calling.

 

as to your last statement, so...? if it's less expensive to farm out clerical, billing, coding and payment functions to a 3rd party then they should do that. but with single payer, this all gets much less complicated. one process across the system for all these functions and consequently the need for less people to do them

And everything is exactly the same in other countries as it is here, except for there not being single payor, right? The obvious answer is "no." The idiot politicians' "solution" is to ratchet-down physician

Fixed it for you.

 

Birdbrain is right though about the providers of medical care being on the plus side of adding more services than what are necessary. Take the mammogram for example. I believe it was just last year, studies showed women were getting too many breast x-rays, and that they were counterproductive. Another "value add" that Dentists love is the routine x-ray of healthy teeth. "Hey - your insurance covers it." I've been told for the past two years as I've had to sign a waiver at each semi-annual routine teeth cleaning appointment, because I don't want my skull irradiated. His new Mercedes payment, be damned.

 

I can't help but marvel though at the docs that are aligned with the single payer option and crow that its more efficient and they will get the providers to accept less for their services. Their services... THEIR services. I thought that was one of the problems. Medicare & Medicaid paying 10¢ on the dollar for THEIR services to such an extent that the ranks of future generations of medical care providers would be filled - not by some of the best and brightest - but by others who more traditionally work in such lower paying professions.

Yep. As I've been saying, it's going to get ugly. No tort reform means malpractice insurance continues to rise, in the face of smaller salaries, leading to a double-whammy. Medical school still costs a ton to attend, especially in conjunction with undergrad, and that money investment and the time investment (12 years usually post-HS, meaning no real money made until one is age 30) will drive people out of going to the medical field/medical school and instead into PA and nursing school, where training is inadequate. As for the respect and prestige? It's gone.

 

By the way, I love how the evil insurance megaliths bent on making profit at the expense of the patient are actually the ones doing the back office work for Medicare.

One of the reasons why Medicare is called "more efficient" than private insurance. But when the gubment gets a hold of it, it will become the model of efficiency, just like ever other thing run by the gubment.

[GG]

I just ordered a book that I found out about from a book review in the latest New Yorker. The review references two similar books, one by Bruno Rizzi published in 1939 called the "Bureaucratization of the World," and the other by James Burnham published in 1941 called "The Managerial Revolution." Both authors argued that the world would eventually be taken over by major powers ruled by entrenched bureaucracies that cared little for the populous. I ordered the Burnham book, as it says Orwell's "1984" was influenced by this one. JK Galbraith also acknowledges this book as influencing his "The INdustrial State." A quote of Burnham's book from the review, "The economies of the major powers had fallen into the hands of a new elite: the managers, executives,financiers, and stockholders who owned and ran corporations, and the government administrators who regulated them." Doesn't sound to far off...

 

I can see how someone might get governments and large corporations confused and lump them all in the same bureaucratic morass. But corporations have to deal with capitalism's creative destruction and shareholder pressure. The government does not. That's why there's a constant turnover among Fortune 500, and little change in government. It's naive to pretend that the fears of the '30s have materialized wrt corporations. If companies don't constantly adapt, they don't survive for a long time.

[B-Large]

ok. i agree this article didn't support single payer or the aca as the solution. it wasn't really about solutions. it illuminated the problems, which are many. there is no single solution but for problems so deep i believe fundamental change is required. that's not what many folks are proposing. they believe the market place can solve these issues. i believe the free market in health care is much of the problem. buying and selling care for a heart attack isn't in any way similar to buying a big screen tv or car. and that truth is well illustrated in this piece.

 

I am beginning to believe Healthcare has no true "free market" solution like many other industries. In tradtional markets, people bow out of a market and pursuit of an item/ervice when the cost outweighs the benefits of acquiring the good or service... in healthcare, there is lterally no cost to high to most people in saving their lives, they won't question treatment options, they won't question lab tests, they won't question how many nights they stay inpatient... they have gotten sick not by their choice, but sure as heck want to stay alive... people desire the best no matter the cost or length of travel, so what other market works like that? None, that is the issue...

[birdog1960]

I am beginning to believe Healthcare has no true "free market" solution like many other industries. In tradtional markets, people bow out of a market and pursuit of an item/ervice when the cost outweighs the benefits of acquiring the good or service... in healthcare, there is lterally no cost to high to most people in saving their lives, they won't question treatment options, they won't question lab tests, they won't question how many nights they stay inpatient... they have gotten sick not by their choice, but sure as heck want to stay alive... people desire the best no matter the cost or length of travel, so what other market works like that? None, that is the issue...

agree completely. and when they get the huge bill, whatever goodwill once existed between the patients and "providers" is destroyed. that's why i think doc perceives that prestige and respect for the medical profession is gone (btw, i don't agree with him). in many cases the doctor patient relationship has become a business client:provider relationship. it shouldn't be but that's a direct result of this system.

[DC Tom]

I am beginning to believe Healthcare has no true "free market" solution like many other industries.

 

Sure it does. You can't afford care, you die.

[B-Large]

Sure it does. You can't afford care, you die.

 

lol.... yes, you are correct, that is a free market solution...

 

I tdink that is why I've always liked the high deductible plans as an approach to healthcare payment. One of the issues right now is the is no direct Pain when most people get medical services... sure a $40 copay is annoying, but premiums are taken out like income taxes, so you don't really feel them acutely, even though you know they are being deducted from the paycheck.

 

If you had to cover $10,000-$15,000 of an illness, you have to bet most people would be making hard decision to what that care is worth... on the flip side, there are people who might forgo treating their diabetes, so in the end that kind of delayed maintenance could be more costly to the system over all...

 

Its complex, its inefficient, and we all know it isn't inexpensive....

Edited March 4, 2013 by B-Large

[B-Large]

agree completely. and when they get the huge bill, whatever goodwill once existed between the patients and "providers" is destroyed. that's why i think doc perceives that prestige and respect for the medical profession is gone (btw, i don't agree with him). in many cases the doctor patient relationship has become a business client:provider relationship. it shouldn't be but that's a direct result of this system.

 

Yeah, the days of house visits and inviting your doctor over for dinner seem to be long gone. Honestly, providers here are hustling to produce RVU's to cover the salaries and benefits, so they are focused on volume and will atest they have lost that freedom really spend time with a pateint and really deliver the care they thought they would be when they sought out to practive medicine. The providers in private practices are screwed, they cannot keep up with Academic Medical Center and Big Hospital Systems, too expensive and far too many hours for the payoff... its sad

[TPS]

I can see how someone might get governments and large corporations confused and lump them all in the same bureaucratic morass. But corporations have to deal with capitalism's creative destruction and shareholder pressure. The government does not. That's why there's a constant turnover among Fortune 500, and little change in government. It's naive to pretend that the fears of the '30s have materialized wrt corporations. If companies don't constantly adapt, they don't survive for a long time.

While many idustries are subject to Schumpeterian forces, there are quite a few that are not. The Military-Industrial Complex for one. The largest firms have more than 50% of their sales tied to government contracts, which is why they have so many ex-generals on their payrolls. I think there are many industries that are highly concentrated and rely on their connections to government regulators and politicians to keep their industries less competitive and/or provide tax breaks to bolster profits. Regulations are designed make it difficult for smaller companies to compete with the bigger ones, because bigger companies can "afford" to meet regulations easier than smaller companies.

 

It's as if there are really two economies: one for the insiders; and one for the rest of us.

Edited March 4, 2013 by TPS

[GG]

While many idustries are subject to Schumpeterian forces, there are quite a few that are not. The Military-Industrial Complex for one. The largest firms have more than 50% of their sales tied to government contracts, which is why they have so many ex-generals on their payrolls. I think there are many industries that are highly concentrated and rely on their connections to government regulators and politicians to keep their industries less competitive and/or provide tax breaks to bolster profits. Regulations are designed make it difficult for smaller companies to compete with the bigger ones, because bigger companies can "afford" to meet regulations easier than smaller companies.

 

It's as if there are really two economies: one for the insiders; and one for the rest of us.

 

Is that a Pavlovian response, or have you actually looked at the defense contractors' financial statements that prove their government connections give them a leg up on the rest of the industrial sector? I'm sure the folks at Grumman agree with your assertion that defense contractors are protected from creative destruction.