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Old 05-11-2021, 04:35 PM   #1
jmeghunts
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Default The Cost of Care

I have gotten into a new podcast (10 part series) called The Cost of Care. The author is an economist in the healthcare industry and in the first 5 episodes he's given his personal history and is outlining the big problems with cost and billing. I don't think he will ultimately advocate for a single-payer system but the dude is probably gonna drop some good hot sports opinions on the topic in the last half of the series.

Interesting quote from an early episode, "90 of 99 Canadians surveyed said that they love their healthcare system". That shocks me because we hear all the bad things about government healthcare here.

So here is my question for you green screeners: What's the biggest problem with our healthcare system right now? If you were king for a day, what would you change about it?

I'm not taking a side and there are no wrong answers, just looking for input.

https://www.lemonadamedia.com/show/thecostofcare/
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Old 05-11-2021, 05:20 PM   #2
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There is a huge disconnect between the service provider and the patient when it comes to billing / costs.
Where else do you go that you donít know how much what you are buying will cost?

Every medical provider should be mandated to post their price of service for any procedure they do. No different than a menu at a restaurant.
People are oblivious to the costs and thatís exactly what the insurance companies want.

The two major issues
1. Insurability or pre-existing conditions
2. Cost

Solution
1. Anyone is insurable but the cost is associated with your health meaning you a severely obese smoker with heart disease doesnít pay the same premium as a healthy person with heart disease.
2. Have to break the relationship between the Provider and the insurance companies
All Costs for any procedure have to be stated prior to the service and there needs to be a cash option offered
There also needs to be significant discounts for taking care of yourself and penalties for not taking care of yourself. The healthy should not subsidizing those that arenít.




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Old 05-11-2021, 05:47 PM   #3
jmeghunts
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Originally Posted by OldRiverRat View Post
There is a huge disconnect between the service provider and the patient when it comes to billing / costs.
Where else do you go that you donít know how much what you are buying will cost?

Every medical provider should be mandated to post their price of service for any procedure they do. No different than a menu at a restaurant.
People are oblivious to the costs and thatís exactly what the insurance companies want.

The two major issues
1. Insurability or pre-existing conditions
2. Cost

Solution
1. Anyone is insurable but the cost is associated with your health meaning you a severely obese smoker with heart disease doesnít pay the same premium as a healthy person with heart disease.
2. Have to break the relationship between the Provider and the insurance companies
All Costs for any procedure have to be stated prior to the service and there needs to be a cash option offered
There also needs to be significant discounts for taking care of yourself and penalties for not taking care of yourself. The healthy should not subsidizing those that arenít.




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Very good points. I agree on the cost of service, when you walk in there should be a list of fees so that you know what you are paying.
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Old 05-11-2021, 05:49 PM   #4
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The provider should give everyone the same price. I recently had implants put in both eyes. Billing was for $41,000. Insurance paid about $4000 and I paid about $600. If I didn't have insurance the price would be about $41,000 and they would expect me to pay every penny of it. What makes insurance dollars better than my dollars? I can even pay faster than the insurance company.
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Old 05-11-2021, 06:02 PM   #5
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Several good points made already. I am of the opinion that our exorbitant costs are driven mostly by those people that receive services but don’t pay. IE, people using the hospital ERs as their primary care provider for all things minor. Then we have hospitals that can’t deny service to anyone, so they have to accept and treat people for any reason, regardless of ability to pay.

I think my solution would be to have private pay hospitals (cash and insurance) and government supported hospitals. If you can’t pay cash or have insurance, go the the government supported one. The government is already subsidizing a large segment of this population already, so let them have their own medical services. The cash payers or insurance supported payers won’t be burdened with the cost of care for everyone else.

Then, there needs to be transparency in billing and charges from the insurance companies.
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Old 05-11-2021, 09:28 PM   #6
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Several good points made already. I am of the opinion that our exorbitant costs are driven mostly by those people that receive services but donít pay. IE, people using the hospital ERs as their primary care provider for all things minor. Then we have hospitals that canít deny service to anyone, so they have to accept and treat people for any reason, regardless of ability to pay.

I think my solution would be to have private pay hospitals (cash and insurance) and government supported hospitals. If you canít pay cash or have insurance, go the the government supported one. The government is already subsidizing a large segment of this population already, so let them have their own medical services. The cash payers or insurance supported payers wonít be burdened with the cost of care for everyone else.

Then, there needs to be transparency in billing and charges from the insurance companies.


I understand your point but govt paid just means we pay via taxes
Kinda the same situation
Iím not sure how you solve the whole emergency room bs
I think you would save billions by denying care, especially gynecological care for illegals dropping babies every day for free


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Old 05-11-2021, 10:04 PM   #7
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it's really a very simple solution to a complex set of problems. people know there's something wrong and we can go on all day listing the them. at the end of the day what it comes down to is that the medical industry has finagled themselves a de facto exemption to monopoly and anti-trust laws. they hide their costs, charge different rates for different people for identical quantity and quality, and will massively upcharge in emergency situations. everything they do with regard to medical billing practices is blatantly illegal with laws on the books for over 100 years (sherman anti-trust act) and anyone in literally any other industry would get their @$$3$ sued off if they tried it.

$10/gal gas right before a hurricane hits? obviously price gouging. you get rolled in on a gurney because of a heart attack and the hospital charges $4k for a $400 scan? in essence these are the same thing but the hospital gets to build shiny new water fountains and the gas station gets sued by the state.

i could write 5k words on this in one sitting easy, but i'll stop here for now. up until this critical race theory BS there was no other topic in the US that was so unjust to society as a whole.
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Old 05-11-2021, 10:14 PM   #8
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alright i couldn't stop my self. the biggest and easiest example to prove the illegal monopoly of the medical industry is to look at diabetics. Insulin and the various other supplies they need on a daily basis, just to stay alive, has been relatively unchanged for decades. yet here in the USA if you don't have insurance to supplement the cost of insulin and supplies you either have to ration it, steal it, or hope for the best because it's hundreds of dollars per month on the low side to buy out of pocket, if you can even find some place to sell to you. but you can get on a plane and fly to india (or at least before covid) and buy literally years worth of diabetic supplies for the cost of a few months of supplies here. now normally, such a price discrepancy would incentivize entrepreneurial spirits to simply move product from there to here, except there's laws against it. we have a government protected monopoly in the medical industry.

i saw somewhere that a dose of scorpion antivenom in Brownsville, Texas was $20,000 when administered in an emergency situation. but just across the river in Mexico it was like $250.

A few years ago my aunt needed two root canals done. it was significantly cheaper for her to go to Costa Rica and have the procedure done there. Oh and then she stayed there for two weeks. the full trip plus dental work there was cheaper than her copay here in Texas.
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Old 05-11-2021, 10:56 PM   #9
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Going back in time, before Fing Obama care, and get the costs back down and the deductibles back down. And keep the government completely out of health care. Then not let insurance companies, have any lobbying power, to get laws written in their favor. Obama care completely screwed our health care system and the whole country. Oh wait, I am wrong, it is great if you are an illegal alien. But if you are a citizen of this country, you are getting the big chorizo, thanks to Obama.

If you like Canadian health care, you should move to Canada, I like my country the way it was before things really started getting screwed up Once you start accepting one part of the socialist system, they will force the rest of the socialist system on you, like they are trying to do to us now. I think they are trying to just jump straight to communist system.

Last edited by RifleBowPistol; 05-11-2021 at 11:01 PM.
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Old 05-12-2021, 07:02 AM   #10
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Quote:
Originally Posted by dhall1414 View Post
it's really a very simple solution to a complex set of problems. people know there's something wrong and we can go on all day listing the them. at the end of the day what it comes down to is that the medical industry has finagled themselves a de facto exemption to monopoly and anti-trust laws. they hide their costs, charge different rates for different people for identical quantity and quality, and will massively upcharge in emergency situations. everything they do with regard to medical billing practices is blatantly illegal with laws on the books for over 100 years (sherman anti-trust act) and anyone in literally any other industry would get their @$$3$ sued off if they tried it.

$10/gal gas right before a hurricane hits? obviously price gouging. you get rolled in on a gurney because of a heart attack and the hospital charges $4k for a $400 scan? in essence these are the same thing but the hospital gets to build shiny new water fountains and the gas station gets sued by the state.

i could write 5k words on this in one sitting easy, but i'll stop here for now. up until this critical race theory BS there was no other topic in the US that was so unjust to society as a whole.
Agreed. Transparent billing is a huge issue.
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Old 05-12-2021, 07:11 AM   #11
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Originally Posted by RifleBowPistol View Post
Going back in time, before Fing Obama care, and get the costs back down and the deductibles back down. And keep the government completely out of health care. Then not let insurance companies, have any lobbying power, to get laws written in their favor. Obama care completely screwed our health care system and the whole country. Oh wait, I am wrong, it is great if you are an illegal alien. But if you are a citizen of this country, you are getting the big chorizo, thanks to Obama.

If you like Canadian health care, you should move to Canada, I like my country the way it was before things really started getting screwed up Once you start accepting one part of the socialist system, they will force the rest of the socialist system on you, like they are trying to do to us now. I think they are trying to just jump straight to communist system.
Agreed

Canadaís system and the UKís system are so good people with money come here.
Our system no doubt had issues made worst by obumma but itís still the bet system there is
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Old 05-12-2021, 08:06 AM   #12
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Not enough time for a Dr to really know their patients. In and out. Prescription scatter shooting. Not doing the extra test to rule unknowns out. Not doing comprehensive workups to know genetic disposition, allergies, vitamin deficiency. Not staying trained up once graduation from med school. The list goes on.

When we look at the medical field we see much higher numbers and rates of "accidental deaths" than other job fields with people's lives in the balance.

Who here hasn't had to be your own or someone else's advocate when the medical care being received is causing more harm than its helping?

I dont know the answer but the obvious starters would be a electronic patient chart, required comprehensive workup for all patients, standardized continuing education, etc.

The ken burns doc on the mayo is eye opening. The secret to their success is that all the patients medical disciplines are under the same roof and communicate with each other before a course of action is decided. Seems simple enough.
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Old 05-12-2021, 01:01 PM   #13
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I own a health care business. I get to see things through every lens possible. I see at personally as a insured employee that uses the same insurance I offer my employees. I see it as a provider that gives and bills for care. I see from the family/patient perspective that receives the care we offer as I have cared for some of my loved ones.

Private health insurance is the biggest problem. They deny care, delay care, slow pay, intentionally go out of their way to deny legitimate claims...basically lie cheat and steal at every possible opportunity and all in the name of the share holder. Last time I looked United Health care was in the top 10 or 15 in the USA in market cap and revenue.

For all those folks so far that have mentioned transparency in cost, I think ultimately a private pay patient will get as good or better of deal than a insurance company or Medicaid/Medicare will get. You just have to negotiate. And yes healthcare costs vary from market to market state to state and region to region. Think of it like a restaurant. A burger at McDonalds in rural Texas is going to cost less than a steak dinner at a fancy restaurant in NYC.

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Old 05-12-2021, 01:25 PM   #14
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#1 problem with our health care system?

The industry is 100% focused on what to do once you get sick. Why not start focusing on what to do so that you don't get sick in the first place???

Once you realize that, then start following the money. For insurance companies and Dr's, there is no money to be made if people stay healthy. All the money is in pills, surgery, etc, in general, treating the symptoms, not the cause of the symptom.

Also OP, I wouldn't believe a stat like 90 of 99 Canadians like their health care. I've met way too many Canadians that come to America to get treated for basic stuff (Like the flu) that they would have to wait days for treatment for in Canada. I've met dentists who make all their money in the first nine months of the year, so they just go on vacation the remaining three months. I've met dr's that complain about the Canadian bureaucracy. I've worked with guys in Canada who, after having gotten hurt (One guy broken arm, another a pretty severe cut), drove to and crossed the border into America while injured, to be treated.

There is no way that stat is true. If it is, it's a highly isolated case.
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Old 05-12-2021, 01:39 PM   #15
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A few things:

We have two examples of government run healthcare in the US. The VA and CMS...I've seen too many examples of how horrible they are with literally rationing of care, poor care and horrible referral wait times, yet alone for primary care. I do not think it is a good system for quality patient centered care.

I think we need de-regulation to some extent and encourage more private competition. It's literally a monopoly of giants running the private sector...aka BC/BS etc....

I've been a patient of the VA, I'm in healthcare as a physician...these are just my experiences and partial conclusions I've drawn. At the end of the day, I'm just a worker bee and nobody gives a **** what doctors think...not insurance companies, not the government, not hospitals and not most patients.
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Old 05-12-2021, 01:48 PM   #16
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Put a hard cap on malpractice settlements, and put hard and fast rules on filing them that help weed out the welfare grabbers.


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Old 05-12-2021, 02:19 PM   #17
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End the third party payment system for all but the most catastrophic/costly of medical conditions to treat. Cash for everything else via HSA for everyone that can be tapped into at retirement to incentivize actually taking care of yourself when you're younger. The lifestyle you adopt in your 20's and beyond will save you from a lot of the age related decline we see when we enter into our 70's and beyond. And FFS, stop eating **** food. Shop the outer aisles. It's not rocket science.
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Old 05-12-2021, 02:46 PM   #18
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Originally Posted by WItoTX View Post
#1 problem with our health care system?

The industry is 100% focused on what to do once you get sick. Why not start focusing on what to do so that you don't get sick in the first place???

Once you realize that, then start following the money. For insurance companies and Dr's, there is no money to be made if people stay healthy. All the money is in pills, surgery, etc, in general, treating the symptoms, not the cause of the symptom.

Also OP, I wouldn't believe a stat like 90 of 99 Canadians like their health care. I've met way too many Canadians that come to America to get treated for basic stuff (Like the flu) that they would have to wait days for treatment for in Canada. I've met dentists who make all their money in the first nine months of the year, so they just go on vacation the remaining three months. I've met dr's that complain about the Canadian bureaucracy. I've worked with guys in Canada who, after having gotten hurt (One guy broken arm, another a pretty severe cut), drove to and crossed the border into America while injured, to be treated.

There is no way that stat is true. If it is, it's a highly isolated case.
I did a few searches and the responses were all over the map on Canadian healthcare. Some love it, some hate it, some complain about the wait times, some say they never wait. Guess it just depends on who ya ask.
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Old 05-12-2021, 02:48 PM   #19
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Originally Posted by Jmh05 View Post
A few things:

We have two examples of government run healthcare in the US. The VA and CMS...I've seen too many examples of how horrible they are with literally rationing of care, poor care and horrible referral wait times, yet alone for primary care. I do not think it is a good system for quality patient centered care.

I think we need de-regulation to some extent and encourage more private competition. It's literally a monopoly of giants running the private sector...aka BC/BS etc....

I've been a patient of the VA, I'm in healthcare as a physician...these are just my experiences and partial conclusions I've drawn. At the end of the day, I'm just a worker bee and nobody gives a **** what doctors think...not insurance companies, not the government, not hospitals and not most patients.
So your a doctor, I got a question. Have you ever thought about just printing a menu up to leave in the lobby for your patients?

Stitches: $10 each
Xrays: $50 each
Prostate Exam: $5000 each (limit 2 per visit)


Can medical billing really get that simple?
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Old 05-12-2021, 02:58 PM   #20
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Originally Posted by JBJTX81 View Post

And yes healthcare costs vary from market to market state to state and region to region. Think of it like a restaurant. A burger at McDonalds in rural Texas is going to cost less than a steak dinner at a fancy restaurant in NYC.
The way it is now, that McDonalds burger may be priced different to everyone standing in line in the same store.
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Old 05-12-2021, 03:25 PM   #21
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Quote:
Originally Posted by Jmh05 View Post
A few things:

We have two examples of government run healthcare in the US. The VA and CMS...I've seen too many examples of how horrible they are with literally rationing of care, poor care and horrible referral wait times, yet alone for primary care. I do not think it is a good system for quality patient centered care.

I think we need de-regulation to some extent and encourage more private competition. It's literally a monopoly of giants running the private sector...aka BC/BS etc....

I've been a patient of the VA, I'm in healthcare as a physician...these are just my experiences and partial conclusions I've drawn. At the end of the day, I'm just a worker bee and nobody gives a **** what doctors think...not insurance companies, not the government, not hospitals and not most patients.
I would agree with you in regards to the VA. Its one of the most poorly run systems in our govt. I would disagree with you in regards to CMS. I'd prefer working with CMS over pretty much any non govt health insurer I've had the pleasure of dealing with.
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Old 05-12-2021, 08:25 PM   #22
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Quote:
Originally Posted by jmeghunts View Post
So your a doctor, I got a question. Have you ever thought about just printing a menu up to leave in the lobby for your patients?

Stitches: $10 each
Xrays: $50 each
Prostate Exam: $5000 each (limit 2 per visit)


Can medical billing really get that simple?
Good question.

That's a good deal on the prostate exam
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Old 05-12-2021, 08:46 PM   #23
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The provider should give everyone the same price. I recently had implants put in both eyes. Billing was for $41,000. Insurance paid about $4000 and I paid about $600. If I didn't have insurance the price would be about $41,000 and they would expect me to pay every penny of it. What makes insurance dollars better than my dollars? I can even pay faster than the insurance company.
I don't disagree with you on the discrepancy between what is billed and what insurance companies actually pay. But I do disagree with the idea that you would have paid the same amount billed to the insurance if you didn't have insurance. I have had basically catastrophic only insurance for years and pay for my family's medical bills out of pocket. We have found when you ask for a cash price on everything from routine care to MRIs to procedures it's typically 25-35% of the original "insurance" price. I have paid $350 for an MRI when the insurance cost was $2000. Have had procedures for about the same reduction for paying cash. Most Dr's will gladly accept cash payment immediately at a discounted rate vs dealing with insurance payments.

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Old 05-13-2021, 03:33 PM   #24
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Good question.

That's a good deal on the prostate exam
Yeah and he probably won't answer. I have never ever got a doctor to answer me on simple billing.
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Old 05-13-2021, 04:01 PM   #25
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It is funny that everyone is targeting the physicians/providers. Google the trend of physician salary vs hospital administrator salary over the last 20+ years...we have a system the uses "insurance" unlike any other insurance in that we file a claim with every interaction with the the medical system...we don't file a claim with homeowner insurance to change a light bulb
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Old 05-13-2021, 04:34 PM   #26
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It is funny that everyone is targeting the physicians/providers. Google the trend of physician salary vs hospital administrator salary over the last 20+ years...we have a system the uses "insurance" unlike any other insurance in that we file a claim with every interaction with the the medical system...we don't file a claim with homeowner insurance to change a light bulb
Another very good point. I'm all for lowering rates and having a catastrophic-only policy. I can handle most things out of my HSA account.

Edit: But if we do that I want to know up front how much I'm spending.

Last edited by jmeghunts; 05-13-2021 at 04:42 PM.
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Old 05-13-2021, 04:42 PM   #27
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Another very good point. I'm all for lowering rates and having a catastrophic-only policy. I can handle most things out of my HSA account.

Edit: But I do that I want to know up front how much I'm spending.
I think this is a feasible solution. Make most things a reasonable price that majority can afford on their own, but reserve insurance for the things that would be financially devastating to most of the population such as cancer or cardiothoracic surgery
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