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Thread: The health care debate thread.

  1. #1
    Administrator U-Ute's Avatar
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    The health care debate thread.

    This thread is here instead of in the health forum because it is intended to be the landing spot for the debate concerning our current health care system, which I'm sure most of us agree is broken to some extent. The broken nature of which is contributing significantly to the budgetary problems our country currently faces.

    To that end, I bring a slightly different look at the problem. Instead of looking at "how do we pay for it", this piece from Time magazine takes a look at "why is it so expensive to begin with".

    While it does lean a bit left in the conclusions it makes at the end concerning Medicare and a single payer system, I think it takes a good deep look into the world of medical charges. It helps answer some of the questions I had when I was looking at the bills coming out of my wife's two trips to the ER last year for kidney stones. It is a lengthy read, but it is worth it whether you are left or right.

  2. #2
    Yeah I liked that Time article. I spent 4 years working across the street from MD Anderson in Houston so I liked his description of the Texas Medical Center glass skyscrapers as reminiscent of Dubai. Sure seems like there's something wrong with that when people are getting fabulously wealthy off the backs of people who are sick and dying and paying tens of thousands of dollars in hope of possibly extending their life a few months in the face of cancer.

    "Rescue" medical care in this country is awesome. I think people who get in car accidents, have heart attacks, have septic shock, etc. in this country generally get amazing care and have really great outcomes. Cancer care is great in this country as well. And this care is legitimately expensive, although not as expensive as hospital charges obviously.

    Why is health care so expensive? Because patients don't ask (and if they ask then nobody knows the answer to the question) "How much is this going to cost?" Patients only ask, "My insurance is going to cover this, right?" Since "somebody else" is paying the costs skyrocket.

    Really there are two ways to fix health care: 1. Price transparency with high-deductible insurance and the majority of costs for the majority of patients paid from health savings accounts OR 2. Single payer government health care, extending basic Medicare/Medicaid type coverage to everyone.

    Option 1 would work if costs and quality/outcomes for every visit and every procedure test were mandated to be posted on the internet by every health care provider and patients paid out-of-pocket (had "skin in the game") for all this stuff. That would bring back competition and price transparency that is now sorely lacking. But I think eventually this country will work itself to Option 2 because that is where public sentiment seems to be in my experience. That's why Obama won the election. People who have no problem paying $1000 for a car repair bill are outraged if they have to pay $1000 for a medical bill. Most people don't want to take personal responsibility for the cost and quality of their own health care -- people want their taxes to pay for it and the government to regulate it tightly. And I do think that probably at the end of the day single payer government funded health care will be the most efficient and cheapest system that we could have.

  3. #3
    I am a universal health care advocate. The tax burden is heavy but, in my estimation, it is worth it. My family greatly benefits from access to universal health care. The article linked below, however, highlights some of the potential problems with the system, especially in smaller or, rural communities:

    A decade of pain: The only foot surgeon in Nova Scotia has waiting list 3,500 names long

    http://news.nationalpost.com/2013/02...00-names-long/

    “I know you have to wait your turn in Canada,” Ms. Berringer says. “I understand that. But sometimes the system doesn’t seem to work for the people that need it.

    “I am kind of back to full circle, back to Dr. Glazebrook, and he has a 3,500-person waiting list. I have waited over 10 years to see him and I’m not getting any younger, you know.”

  4. #4
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by CardiacCoug View Post


    Really there are two ways to fix health care: 1. Price transparency with high-deductible insurance and the majority of costs for the majority of patients paid from health savings accounts OR 2. Single payer government health care, extending basic Medicare/Medicaid type coverage to everyone.
    You're right. I think. What's interesting (and frustrating/funny) is that people seem to want the choice that (1) would give them, but they don't want to pay for that choice or take responsibility for their own healthcare. Obamacare will push us towards (2), I think, and we'll be there in 20 years or less. Maybe 10.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    "Nine tenths of wisdom consists of being wise in time."
    --Theodore Roosevelt


  5. #5
    Here is an interesting tidbit. There are ~10 million people in Michigan. We are expecting that by the end of 2014 roughly 11% of all those in Michigan will be on some sort of individual health plan (IE they don't get their insurance from work). The health care exchanges are going to be a BIG game changer.

    To put that in perspective. The Health Plan I work for has about 450k members of which 5k of them are individual plans (1%). If things hold up expectations then ~45k more members will be moved to Individual plans

  6. #6
    Sam the Sheepdog LA Ute's Avatar
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    MRD, what impact do you see health care exchanges having on the insurance markets? Here in CA the system is shaping up as a very intrusive one (no surprise).

    Meawhile, here's a interesting blog post on the "volume to value" trend:

    Divided Healthcare Nation

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    "Nine tenths of wisdom consists of being wise in time."
    --Theodore Roosevelt


  7. #7
    Quote Originally Posted by LA Ute View Post
    MRD, what impact do you see health care exchanges having on the insurance markets? Here in CA the system is shaping up as a very intrusive one (no surprise).
    As I said before they are going to be a gigantic game changer. The subsidies by the feds and state will drive how successful those exchanges are. I would expect more and more companies to just provide a subsidy and their employees go to private (and public) exchanges.

  8. #8
    I watched a report on 60 minutes about six months ago, or so, and they were talking about concierge systems and how they work. Apparently, an average cost of an MRI test, as priced through a hospital and paid by risk transfer (some type of insurance), is approximately $10,000. When the same procedure was priced through a concierge system that operated on a cash basis for patients the cost was $300, for the same tests/procedures (I know that repetition is redundant, but I think this point deserves some attention). Now when I ask about medical service I always ask about cash pricing. It has made sense to pay some expenses from my pocket (MSA) and disregard annual deductible limits.

    I have been happy so far with my concierge/cash approach, and have persuaded my family physician to accept cash payment for a 40% across the board reduction in cost. The only problem is that this discount does not extend to tests or procedures outside of his office, so it is an incomplete approach. Still, it's the health insurance companies driving this chaos. I also wonder what impact on the economics is produced by the legal sysytem and it's effects on doctors, hospitals and care.

    I wonder if a true free market existed in health care what would be the result?

  9. #9
    Living in the past ... FMCoug's Avatar
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    I am self employed with a $ 6000 deductible. Just brought my wife come from getting some outpatient surgery. This is gonna hurt.

    But I am a middle class white guy so I have obviously got too much money anyway.

  10. #10
    Healthcare is an interesting market, because when people need it, they're far less likely to shop dispassionately, as you might when you're evaluating a purchase of a dishwasher, for example.

    "My mother has breast cancer, and I've found a place that offers 40% off radiation treatments this month!" It doesn't quite work that way, neither does it work for emergencies, like who does price shopping for bypass operations while they're in a medical helicopter?

    When there's something wrong with your body, you entire being, your existence, is at stake. And when we see the same level of distress in others, we empathize, which is why Reagan signed the law that mandates emergency rooms treat people who need emergency care, regardless of their ablity to pay. This single law has caused a great distortion in the whole market, with attendant cost shifting, the cat-and-mouse games people play when they go to the ER, etc.

    If we wanted to truly incentivize the free market in healthcare, give hospitals the ablity to turn people away who don't have insurance or enough $$$$ on the spot to pay for their treatment. Sure, this will result in some people dying on the front lawns of emergency rooms, but it will send the message to everyone else that they need to have insurance, and THEN the cost shifting problem will start to evaporate.

    The biggest problem with this is it's totally against what Jesus taught, and when it comes down to it, Americans have a hard time being brutally Darwinistic.

    It's hard - and maybe unrealistic - to fully apply the free market to healthcare.

  11. #11
    Even if you had time, How would you price shop procedures? It's not like you can call around and say, yeah, I'm a 1978 Caucasian from Buffalo, what would you charge to replace my starter... and what if you used aftermarket parts? Complications arise during surgeries, things turn out to be worse than originally thought, procedures change on the fly. You may have multiple providers working on you (anesthesia etc), are you going to try to price shop all of them?

    Most patients don't have the knowledge of what's wrong with them to do something like that. Regardless, if I have someone call me and they have a high IQ of what's going on and what they need to do a price comparison, I'm going to do my own assessment. That costs additional money, even if you bring your labs/x-rays etc.

    Also, how variable do you think healthcare prices are? As variable as washing machine prices?

  12. #12
    I'm not sure why a patient would have to try to bargain shop a service or procedure. There are referral networks operating now, whether it's physician or provider facilitation, it's a referral service. Concierge networks would presumably operate in the same way. So if you are now part of a gatekeeper system or hmo or whatever, you would instead be a part of a concierge network where cash is king. Your primary would still refer to specialists. The only difference is that insurers would be out of the picture, mostly.

  13. #13
    It's a clear sign to me that the system is broken that I'm having a huge internal debate as to whether to take my dehydrated toddler who has been vomiting and having diarrhea for the past 36 hours to the ER. His ashen cheeks and sunken eyes are convincing in the affirmative, but it's unfortunate that getting him an IV will set us back an arm and a leg.

    Like many here, we have an independent high deductible HSA plan. The total bills for an ER visit for a head wound Mpfunk had about 6 months ago came back at around $1,800 out of pocket cost for us. And people complain that lawyers overcharge for their time! We were in ER for maybe 40 minutes.
    "Well-behaved women seldom make history." - Laurel Thatcher Ulrich

  14. #14
    Quote Originally Posted by Mrs. Funk View Post
    It's a clear sign to me that the system is broken that I'm having a huge internal debate as to whether to take my dehydrated toddler who has been vomiting and having diarrhea for the past 36 hours to the ER. His ashen cheeks and sunken eyes are convincing in the affirmative, but it's unfortunate that getting him an IV will set us back an arm and a leg.

    Like many here, we have an independent high deductible HSA plan. The total bills for an ER visit for a head wound Mpfunk had about 6 months ago came back at around $1,800 out of pocket cost for us. And people complain that lawyers overcharge for their time! We were in ER for maybe 40 minutes.
    Take him to urgent care. Much cheaper and get him some pedialite

    Sent from my SGH-T999 using Tapatalk 2
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  15. #15
    Quote Originally Posted by Mormon Red Death View Post
    Take him to urgent care. Much cheaper and get him some pedialite

    Sent from my SGH-T999 using Tapatalk 2
    We called about 6 urgent cares. None will place an IV on a 19-month-old. The ER is our only option if we have to take him tonight. Believe me, the urgent care was our first choice. And we're all over the Pedialyte. I do appreciate your response. Thanks.
    Last edited by Mrs. Funk; 02-27-2013 at 08:22 PM.
    "Well-behaved women seldom make history." - Laurel Thatcher Ulrich

  16. #16
    Quote Originally Posted by Mrs. Funk View Post
    We called about 6 urgent cares. None will place an IV on a 19-month-old. The ER is our only option if we have to take him tonight. Believe me, the urgent care was our first choice. And we're all over the Pedialyte. I do appreciate your response. Thanks.
    Get a teaspoon dropper. Give 5 ml of the pedialyte every 10 minutes, until no vomiting for an hour, then give 10 ml every 10 minutes until no vomiting for an hour, then give 20 ml every 15 minutes. If they vomit at any time start over at 5ml every 10 minutes. Keep doing that even if he is vomiting.

    By following this protocol, you can successfully hydrate almost 90% of infants without using an IV.

    Good luck!
    “Man cannot discover new oceans unless he has the courage to lose sight of the shore.”
    André Gide

  17. #17
    Quote Originally Posted by Jarid in Cedar View Post
    Get a teaspoon dropper. Give 5 ml of the pedialyte every 10 minutes, until no vomiting for an hour, then give 10 ml every 10 minutes until no vomiting for an hour, then give 20 ml every 15 minutes. If they vomit at any time start over at 5ml every 10 minutes. Keep doing that even if he is vomiting.

    By following this protocol, you can successfully hydrate almost 90% of infants without using an IV.

    Good luck!
    Thanks for the advice. (And sorry for the threadjack.) The severe active vomiting was more yesterday. He's kept some liquids and a popsicle down recently so the immediate danger is lessened. Today has been 14 diarrhea blowouts. 7 loads of laundry today alone. Ugh.
    "Well-behaved women seldom make history." - Laurel Thatcher Ulrich

  18. #18
    Quote Originally Posted by Mrs. Funk View Post
    Thanks for the advice. (And sorry for the threadjack.) The severe active vomiting was more yesterday. He's kept some liquids and a popsicle down recently so the immediate danger is lessened. Today has been 14 diarrhea blowouts. 7 loads of laundry today alone. Ugh.
    Little kiddos that are sick can be so draining. Ugh! I hope that gets better and u and the mr. can get some rest. It sounds like he might be on the men.

  19. #19
    Quote Originally Posted by OrangeUte View Post
    Little kiddos that are sick can be so draining. Ugh! I hope that gets better and u and the mr. can get some rest. It sounds like he might be on the men.
    Thanks for the good thoughts. He's getting better, yes. On the other hand, mpfunk is sick and I'm succumbing to the same plague. He'll probably be loads better tomorrow. Nothing like caring for an active, healthy child while battling cholera.
    "Well-behaved women seldom make history." - Laurel Thatcher Ulrich

  20. #20
    Could have Patient Center Medical Home be a cost saver for the system

  21. #21
    Sam the Sheepdog LA Ute's Avatar
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    Jenkins: Yes, Hospital Pricing Is Insane, But Why?

    It's a short but interesting piece:

    "What is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?" Mr. Brill asks. But his question is rhetorical since he doesn't exhibit much urge to understand why the system behaves as it does, treating its nature as a given.

    In fact, what he describes—big institutions dictating care and assigning prices in ways that make no sense to an outsider—is exactly what you get in a system that insulates consumers from the cost of their health care.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    "Nine tenths of wisdom consists of being wise in time."
    --Theodore Roosevelt


  22. #22
    Living in the past ... FMCoug's Avatar
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    I've been thinking about this lately and am wondering if we're debating something where the ship has already sailed. Health care is so institutionalized at this point, with the costs totally separated from the consumer, that it's basically like dealing with the government. Is fighting with (insert insurance company here) any different than dealing with (insert government agency here)? Should it just be gov't / single payer and be done with it? I honestly don't know ... not trolling or proposing one thing or another. I just think that most people equate medical stuff (insurance, bills, etc.) about the same as dealing with the IRS or the like.

  23. #23
    Sam the Sheepdog LA Ute's Avatar
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    Here's an interesting perspective from Walter Russell Mead:

    "The world is in the early stages of a golden age of biotech innovation, one that has the potential to revolutionize everything from health care and manufacturing to energy production. And the biotech revolution will build on and add to the infotech revolution that has been shaking the world for the last 50 years. The 21st century will be more different from the 20th than the 20th was from the 19th. And the 22nd century will be something else again, if we don’t kill ourselves en route.


    "VM never gets tired of pointing this out for one very simple reason: wonks who don’t keep the innovative dynamism of our age at the forefront of their minds as they think up new policies are likely to do more harm than good. Trying to build elaborate models for the future of healthcare based on today’s delivery systems and economic models is as futile as trying to build a national transportation model in 1830 based on the success of the Erie Canal...."
    The whole blog post is worth reading.
    Last edited by LA Ute; 03-28-2013 at 11:30 AM.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    "Nine tenths of wisdom consists of being wise in time."
    --Theodore Roosevelt


  24. #24
    So Obamacare is going to cost a lot more than thought. Its nice that the hardest hit states are the ones who voted for Obama.

    But that increase won't be felt evenly across the country because the study forecasts that some states will feel more pain than others. Among the hardest-hit will be Ohio, where claims costs will jump by almost 81%, and California, with a 62% increase.
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  25. #25
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Mormon Red Death View Post
    So Obamacare is going to cost a lot more than thought. Its nice that the hardest hit states are the ones who voted for Obama.
    In the words of the immortal Dan Patrick, they could've done it better.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    "Nine tenths of wisdom consists of being wise in time."
    --Theodore Roosevelt


  26. #26
    Quote Originally Posted by Mormon Red Death View Post
    So Obamacare is going to cost a lot more than thought. Its nice that the hardest hit states are the ones who voted for Obama.
    So the upshot is this?

    What does that mean for individuals? If you're already covered by your employer's plan, not much. But if you're uninsured or buy health insurance directly, the study indicates costs could rise for some people, according to The Associated Press.
    The linked article in the quote says this:

    The Obama administration challenged the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law, such as tax credits to help people afford premiums and special payments to insurers who attract an outsize share of the sick.

    The study also doesn't take into account the potential price-cutting effect of competition in new state insurance markets that will go live Oct. 1, administration officials said.

    At a White House briefing Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can't be compared to the comprehensive coverage available under the law. "Some of these folks have very high catastrophic plans that don't pay for anything unless you get hit by a bus," she said. "They're really mortgage protection, not health insurance."

    Sebelius said the picture on premiums won't start coming into focus until insurers submit their bids. Those results may not be publicly known until late summer.
    Sounds to me like the jury is still out.
    “The world is so exquisite with so much love and moral depth, that there is no reason to deceive ourselves with pretty stories for which there's little good evidence. Far better it seems to me, in our vulnerability, is to look death in the eye and to be grateful every day for the brief but magnificent opportunity that life provides.”
    Carl Sagan

  27. #27
    Quote Originally Posted by UtahDan View Post
    So the upshot is this?
    The linked article in the quote says this:
    Sounds to me like the jury is still out.
    Well seeings how the Obama admin has such a vast history of correctly estimating costs maybe we should disregard the study.
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  28. #28
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Mormon Red Death View Post
    Well seeings how the Obama admin has such a vast history of correctly estimating costs maybe we should disregard the study.
    This is going to be a bumpy transition. Obamacare was designed by people who cut their healthcare policy teeth in the 90s (Nancy-Ann Min DeParle, for example) and they tried to update and cobble together all the "great" (unproven) ideas of that era into a massive package that still keeps people insulated from the cost of their own care and that doesn't recognize the disruptive technological breakthroughs of our own time. They are the

    wonks who don’t keep the innovative dynamism of our age at the forefront of their minds as they think up new policies are likely to do more harm than good. Trying to build elaborate models for the future of healthcare based on today’s delivery systems and economic models is as futile as trying to build a national transportation model in 1830 based on the success of the Erie Canal.
    http://blogs.the-american-interest.c...-smart-policy/

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    "Nine tenths of wisdom consists of being wise in time."
    --Theodore Roosevelt


  29. #29
    Quote Originally Posted by Mormon Red Death View Post
    Well seeings how the Obama admin has such a vast history of correctly estimating costs maybe we should disregard the study.
    No one in government ever gets cost estimates right, seemingly. But at a minimum it at least sounds like there are several more variables to factor in that can't be quantified at this point.
    “The world is so exquisite with so much love and moral depth, that there is no reason to deceive ourselves with pretty stories for which there's little good evidence. Far better it seems to me, in our vulnerability, is to look death in the eye and to be grateful every day for the brief but magnificent opportunity that life provides.”
    Carl Sagan

  30. #30
    Quote Originally Posted by UtahDan View Post
    No one in government ever gets cost estimates right, seemingly. But at a minimum it at least sounds like there are several more variables to factor in that can't be quantified at this point.
    wow... talk about giving them the benefit of the doubt. Obama and his admin underestimated the first law of insurance.

    Moral Hazard: When people have insurance they use it.
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

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