Health Care Discussion

[Spotcheck Billy]

nm

[jsglow]

By the way, warriorchick's own sister was a FFP kid at Dayton and used the opportunity to mature into an absolutely outstanding adult.  But of course there wasn't a scholly that went along with that opportunity and the full financial burden rested on my in-laws (and her).  Personally, I was thrilled to hire a MU FFP following his graduation in 2012 and he's a very valuable and motivated employee.  I do know that he's very passionate about the program and wrote several strongly worded letters directly to Fr. Pilarz.  I must admit that I'm not familiar with the revisions that took place recently.  For those 'in the know' I'd appreciate being further informed.

[Marqevans]

Another84:

I contacted my friend about the whole scholarship issue and targeting the highest level students and this is in summary what she said.

It is an incredibly competitive marketplace for the highest level students.  They can go pretty much anywhere they want and go there for free.  If schools have enough money, they can be very strong in that pool, but for those schools that don't have those resources, concentrating too much on those students can be harmful to their overall academic profile if you don't have the $$ to be competitive for the next level of student.

.

Have to disagree with the  "free" statement. Top schools have so many bright kids that the only way you are getting a scholarship is if you demonstrate financial need.  You need both merit and financial need.

[Coleman]

Sorry, but you are wrong.  I have worked in healthcare for a bit (20 years) too.  Here (http://www.metricmash.com/inflation.aspx?code=SA0,SAM2,SAE1&recession=false&from=200101&to=201112&period=&political=false) is a chart from the US Bureau of Labor Statistics showing the rise in costs, separating out health care (green line) from the overall rate of inflation in the economy (blue line).  If you go to the bottom and tell the chart to show numbers from 1960 to the present, you see an interesting trend.  Up until about 1965, the inflation rate for healthcare closely tracked the overall inflation rate.  Starting in the mid-1960s, the numbers began to diverge...first slowly, then faster and faster.  Why is the mid-60s relevant?  Because the Medicare law took effect on January 1, 1966.

But yeah, keep telling yourself that the rise in healthcare costs has nothing to do with government intervention.

Could also be due to more expensive treatments becoming available such as more advanced chemotherapy, organ transplants, as well as longer life expentancies

But yeah, just ignore other factors to suit your agenda 

[Coleman]

I just don't understand how the U.S., with the least amount of government intervention in the field of healthcare of industrialized countries, spends more, by far, than any other country both gross and per person. How do you explain that one?

+1000000000000

Not only spends more with lower government intervention but also has lower life expectancies than other countries

[mu_hilltopper]

New expensive ways to treat an unhealthier population that is living longer with chronic problems.  There is your problem.  How many MRI's get taken every year?  How many of them necessary?  The cost of pharmaceuticals has increased substantially since there are more identifiable problems with people and there are more pharmaceuticals developed to treat these illnesses.  Life expectancy has increased and thus the burden on medicare has increased.  Sure, the government pays the bills on medicare, but the doctors/insurance companies are also to blame.  Doctors have to cover their own asses due to medical malpractice, so they order more testing (more money!).  Of course, insurance companies are forced to raise the rates to make up for this cost... and a lot of this cost gets passed onto the the customer(government in cases of medicare).

The entire system is a giant CF.  There is no easy fix. 

This.

GoooooMarquette, correlating 1965 and a rise in health care costs with Medicare getting started doesn't hold water.   Lots of factors hit health care finances in the last 50 years, from vast technology advances, pharma advances, life expectancy advances, to obesity rate advances, and dozens more.  

As pux90 wrote, and is fully correct, Federal intervention is widely understood to be a source of cost control in this area.

I'll use your phrase:  "Sorry, but you are wrong."  

[GooooMarquette]

This.

GoooooMarquette, correlating 1965 and a rise in health care costs with Medicare getting started doesn't hold water.   Lots of factors hit health care finances in the last 50 years, from vast technology advances, pharma advances, life expectancy advances, to obesity rate advances, and dozens more.  

As pux90 wrote, and is fully correct, Federal intervention is widely understood to be a source of cost control in this area.

I'll use your phrase:  "Sorry, but you are wrong."  

What do you think led to the overutilization?  Oh, I know - systematically disconnecting purchasing decisions (patient) from payment (government).  If I had to pay for an x-ray, I'd think long and hard about asking for a second one.  But if I know Uncle Sam is paying, I'll go in and demand one.  Not that complicated, fellas.

[mu03eng]

What do you think led to the overutilization?  Oh, I know - systematically disconnecting purchasing decisions (patient) from payment (government).  If I had to pay for an x-ray, I'd think long and hard about asking for a second one.  But if I know Uncle Sam is paying, I'll go in and demand one.  Not that complicated, fellas.

My wife is a PT at a relatively affluent hospital in the Milwaukee area and sees this all the time with the government funded patients.  Gets a patient that is told therapy should be able to treat the issue but surgery might as well and the government backed patient ALWAYS chooses surgery over PT.  PT would be infinitely less expensive and the outcome just as good, but because the patient doesn't care about cost they go for the quick fix.

[mu_hilltopper]

What do you think led to the overutilization?  Oh, I know - systematically disconnecting purchasing decisions (patient) from payment (government).  If I had to pay for an x-ray, I'd think long and hard about asking for a second one.  But if I know Uncle Sam is paying, I'll go in and demand one.  Not that complicated, fellas.

Seriously, are you talking about the US or Canada?  

In the US, the Feds cover about 95 million people. Private health care insurance covers 195 million people in the US.  

What you just wrote about paying for an x-ray?  Goes double for people on private health insurance.

"It's not that complicated, fella."

[Coleman]

My wife is a PT at a relatively affluent hospital in the Milwaukee area and sees this all the time with the government funded patients.  Gets a patient that is told therapy should be able to treat the issue but surgery might as well and the government backed patient ALWAYS chooses surgery over PT.  PT would be infinitely less expensive and the outcome just as good, but because the patient doesn't care about cost they go for the quick fix.

A surgery that would not have been available 60 years ago due to advances in modern technology and medicine. Again, you guys are missing the point.

[Coleman]

Medicare/medicaid is legally required to charge no more than 1.5x what is needed for the procedure and overhead (including the doctor's salary). That's how you control costs.

Medicare also doesn't need to have a profit margin. Medicare doesn't have to pay dividends to shareholders.

Which do you think is really more cost effective?

[mu03eng]

A surgery that would not have been available 60 years ago due to advances in modern technology and medicine. Again, you guys are missing the point.

And an issue that would have been ignored 60 years ago as a scratch.  Yes there are new and more expensive treatments but if people had stake in that expense they would be less inclined to go that route unneeded.

And it's not just newfangled surgeries, I got my ACL replaced and meniscus removed, if I had paid full boat it would have been $50k.  I could have gone through therapy and been good for my life just couldn't have really done sports.  ACL repairs have been around for years, why are they so expensive?  And I had to pay out of pocket to make the call to repair the ACL to a certain level, definitely higher than someone on medicare or medicaid or title 19 or badger care.

[mu03eng]

Medicare/medicaid is legally required to charge no more than 1.5x what is needed for the procedure and overhead (including the doctor's salary). That's how you control costs.

Medicare also doesn't need to have a profit margin. Medicare doesn't have to pay dividends to shareholders.

Which do you think is really more cost effective?

It's not controlling costs, it's diverting them.  Those "unpaid" costs then roll over to the private insurances to pay that cost.  So taxpayers who are insured privately subsidize medicare on the front end(taxes) and the back end(premiums).

[Coleman]

It's not controlling costs, it's diverting them.  Those "unpaid" costs then roll over to the private insurances to pay that cost.  So taxpayers who are insured privately subsidize medicare on the front end(taxes) and the back end(premiums).

You just made the case for a single payer system better than I ever could have. Thanks! 

[GooooMarquette]

Others here have stated:  "Federal intervention is widely understood to be a source of cost control in this area."

On a very simplistic level, this is correct.  If a provider wants to charge $100 for a service like an x-ray, Medicare will usually say that only $80 is covered, and the provider only gets $80.  Cost containment, right?  If you don't look too closely, the answer looks like yes.  But here's the problem:  Medicare keeps paying the provider $80 every time it performs (and re-performs) that service.  So if the provider performs the service once, it gets paid $80; if it performs the service ten times, it gets $800, and so on.  Increased utilization leads to increased overall payment.  In theory, Medicare may deny some after a while...but these controls have proven not to work.

Now recall that the patient - who ultimately makes the decision whether to go back in and ask for another service - often bears little to no financial responsibility for that service.  He can keep asking for more and more, the provider will often keep performing it more and more, and Medicare will keep paying for it again and again.  Sometimes this is because the provider really believes it may help.  Other times it's because the provider is afraid of being sued for malpractice.  And yet other times, it may be due to a truly malicious provider (that's called fraud).  In any event, in this world where the purchasing decision is de-coupled from the payment responsibility, Medicare's superficial "cost containment" strategy will fail.

[ATL MU Warrior]

Others here have stated:  "Federal intervention is widely understood to be a source of cost control in this area."

On a very simplistic level, this is correct.  If a provider wants to charge $100 for a service like an x-ray, Medicare your insurance company will usually say that only $80 is covered, and the provider only gets $80.  Cost containment, right?  If you don't look too closely, the answer looks like yes.  But here's the problem:  Medicare your insurance company keeps paying the provider $80 every time it performs (and re-performs) that service.  So if the provider performs the service once, it gets paid $80; if it performs the service ten times, it gets $800, and so on.  Increased utilization leads to increased overall payment.  In theory, Medicare your insurance company may deny some after a while...but these controls have proven not to work.

Now recall that the patient - who ultimately makes the decision whether to go back in and ask for another service - often bears little to no financial responsibility for that service.  He can keep asking for more and more, the provider will often keep performing it more and more, and Medicare your insurance company will keep paying for it again and again.  Sometimes this is because the provider really believes it may help.  Other times it's because the provider is afraid of being sued for malpractice.  And yet other times, it may be due to a truly malicious provider (that's called fraud).  In any event, in this world where the purchasing decision is de-coupled from the payment responsibility, Medicare's your insurance company's superficial "cost containment" strategy will fail.

FIFY.  You do know that Medicare was modeled after private insurance, correct?  Again, you are correct with a lot of your thinking.  Just don't get your fixation on Medicare being the only (or even major) villian. 

[GooooMarquette]

FIFY.  You do know that Medicare was modeled after private insurance, correct?  Again, you are correct with a lot of your thinking.  Just don't get your fixation on Medicare being the only (or even major) villian.  

I don't disagree with you in terms of the initial problem.  But here's the thing:  Medicare took a relatively small problem and turned into a big problem.  And with the ACA, they took a big probem and turned it into a huge one.  And even though Medicare was originally modeled after private insurance, Medicare has since taken over the lead role in policy and process-making.  So now, every time Medicare does something, private insurers follow...instead of the other way around.  So your "fix" might have recognized the problem back in the 60s and 70s, but today, Medicare is front and center in any discussions about the disconnect between purchasing decisions and payment responsibility.

Don't mean to sound like I'm taking it out on you - you seem to be closer to understanding the issue than most around here.

[mu_hilltopper]

Others here have stated:  "Federal intervention is widely understood to be a source of cost control in this area."

On a very simplistic level, this is correct.  If a provider wants to charge $100 for a service like an x-ray, Medicare will usually say that only $80 is covered, and the provider only gets $80.  Cost containment, right?  If you don't look too closely, the answer looks like yes.  But here's the problem:  Medicare keeps paying the provider $80 every time it performs (and re-performs) that service.  So if the provider performs the service once, it gets paid $80; if it performs the service ten times, it gets $800, and so on.  Increased utilization leads to increased overall payment.  In theory, Medicare may deny some after a while...but these controls have proven not to work.

As ATL MU said, you are correct in some of your thinking, except that it fails to link government intervention as the big reason for increases.

Your 10 x-ray example?   Private insurance pays for x-rays too.  And the re-performance of x-rays.  And they have double the people covered, and way higher reimbursement rates.  For every x-ray Medicare pays for, private insurance is paying for 3.

The private insurance economy is likely 3-4x bigger than what Uncle Sam spends on health care.   

Those facts are incongruous with your idea that the government is to blame for health care increases.

[Chicago_inferiority_complexes]

The private insurance economy is likely 3-4x bigger than what Uncle Sam spends on health care.   

They're both about 50%.

A lot of hilarious liberal talking points in this thread.

I guess it's worked so well for Cuba and Britain, so it must work well here...

[mu_hilltopper]

They're both about 50%.

A lot of hilarious liberal talking points in this thread.

I guess it's worked so well for Cuba and Britain, so it must work well here...

Care to back up your 50% figure?  I got my numbers from this CNN article:  http://www.cnn.com/2012/06/27/politics/btn-health-care  .. 95 million covered by the US Government, private insurance is 196 million.  Do you disagree with their figures?

Not sure if you are aiming that "liberal" comment at me.  I am far from it.

[Canned Goods n Ammo]

They're both about 50%.

A lot of hilarious liberal talking points in this thread.

I guess it's worked so well for Cuba and Britain, so it must work well here...

I have no opinion on the healthcare debate, but this is a douchebag comment and exactly why I hate politics.

You can't have an honest conversation/debate without somebody referring to the other as some sort of right-wing lunatic or a communist.

ugh.

[ChicosBailBonds]

This isn't the proper forum for a full on discussion, I just don't understand how the U.S., with the least amount of government intervention in the field of healthcare of industrialized countries, spends more, by far, than any other country both gross and per person. How do you explain that one?

(Feel free to PM me as I love talking healthcare biz but realize this is a terrible bore to most here with absolutely no relevance to mubb)

Pux, just a little anecdotal stuff.  I spent this morning with my little girl at the doctor's office.  She was diagnosed Type 1 diabetic almost two years ago. Type 1 has nothing to do with diet, it isn't a life choice situation, she just lost the lottery on this one and has to give herself 3 to 4 insulin shots a day because her pancreas doesn't work.

Today we finally got the insulin pump for her which we have been hoping to do for over a year now. Cost of the pump, $8,000 and expected to last 4 years.  That's before a drop of insulin is put in, or test strips used, etc, etc.  Insurance is covering much of it, but there's a healthy out of pocket cost as well. 

Now, on one hand I go, wow, this is expensive stuff.  On the other hand, it's amazing technology that keeps getting better and I want medical companies to be rewarded for finding new technologies.  I'm one that writes a thank you letter to Eli Lilly, for finding the drugs that help her.  I have relatives that write nasty letters to drug companies because of the costs.  Seems, like so many things, people tend to be on one side or the other.  There are tradeoffs with everything.  My sister-in-law from Canada but lives here in Calif, she had her lasik done up in Canada dirt cheap because it was elective and she could choose to wait.  For disease, longer term care stuff her parents are going through, she rails on the system for its inefficiencies, etc.  Tradeoffs everywhere.  We could spend hours talking about the litigiousness of the USA vs other nations in this area, also....plus getting into over prescribed procedures, etc, etc.  Plenty of blame to go around.

[Coleman]

They're both about 50%.

A lot of hilarious liberal talking points in this thread.

I guess it's worked so well for Cuba and Britain, so it must work well here...

Funny you should say that, Cuba and Britain (along with 37 other countries) both have higher life expectancies than us

http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

[mu03eng]

Funny you should say that, Cuba and Britain (along with 37 other countries) both have higher life expectancies than us

http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

Which in no way coorolates to stress levels or health eating habits only medical care?

[mu03eng]

You just made the case for a single payer system better than I ever could have. Thanks! 

Now it proves the current system is dumb.  Single payer doesn't fix it either because that removes all incentives to innovate or be the prefered doctor who can charge a little more.  And single payer is much more susseptible to corruption than the current system