From Sarah Kliff in today's NYT The Morning e-newsletter:
Americans spend more on childbirth than nearly anything else that happens at the hospital. The average delivery is $13,000. Even after insurance pays, patients who have babies still end up on the hook for nearly $3,000.
I've spent 15 years covering the high costs of American health care, an industry in which patients routinely encounter $600 Band-Aids and $3,000 Covid tests. Recently, I've been amazed at how much hospitals, doctors and medical device companies are charging families for newborn care.
They are eking out more money from each step of having a baby. They often tap into the anxiety that so many parents feel as they form new families. "People are willing to do anything to ensure the well-being of their kids even before they meet them," said Neel Shah, chief medical officer at Maven, a women's health clinic.
Health care companies have several chances to make their pitch between a positive pregnancy test and the birth of a child.
In the first trimester, genetic companies sell tests that claim to detect serious and rare problems from a few vials of the mother's blood. But these tests, which can cost thousands of dollars, are usually wrong when they make grave predictions about an infant's health. The inaccurate results can lead parents to spend thousands on more tests and even to consider abortion.
The second trimester often brings a pitch for umbilical-cord blood banking. Brochures in obstetricians' offices describe how paying to freeze and store a newborn's stem cells may be vital if the child becomes ill later in life. But the few parents who try to use their samples often find that they are unusable, either because they have too few stem cells or because they are contaminated. Azeen Ghorayshi and I investigated these companies in a story The Times published today.
Most spending on childbirth goes toward delivery and newborn care. Cesarean section delivery remains the most common surgery in American hospitals, despite years of advocacy to lessen its use. About 30 percent of kids are born this way, more than twice the World Health Organization's recommendation.
One reason is that we have bizarre incentives. Hospitals earn 50 percent more for C-sections than for vaginal deliveries, even though recent research shows they cost less than vaginal deliveries. When cheaper medical care earns more money, that warps behavior.
Neonatal intensive care is also proving to be very profitable. Nearly 40 percent more babies went to these units, supposedly reserved for the sickest kids, from 2008 to 2018. But the infants weren't sicker. Some doctors worry that hospitals may send healthy babies to the NICU because it pays better. Investors, seeing the opportunity, have been buying up neonatology practices.
The experts I talked to have a few explanations for why these efforts work. To start, there are millions of births every year. Hospitals know that childbirth will always make up a large share of their revenue.
Another reason is that the most successful messages — the case for banking cord blood, buying advanced genetic tests or spending a few extra nights in the NICU — are selling safety for your child.
Lastly, these pitches tend to come from a trusted source: our doctors. They distribute brochures that overstate the benefits of cord blood banking or genetic testing. Cord blood banks even pay obstetricians to collect the stem cells. When your doctor endorses a new and promising technology, it is awfully hard to say no.
We learned a lot between our first and second kid by reading the bill from the first delivery. The cost for the OB to stop in the room for max 45 seconds and all how we were doing was over $1000 before insurance. The one that annoyed us the most was the lactation consultant. My first wasnt latching so we asked to see her six times during our stay (caesarean so we had to stay for days). The consultant would come in for a max of two minutes per trip and would make a slight adjustment and declare that everything was fine. Meanwhile my daughter lost over 33% of her birth weight and had to be put on supplemental formula. We ended up contacting a non profit that provides lactation consultants free of charge. She sat with my wife for multiple 30 minute sessions and corrected a lot of the things the hospital lactation consultant had told my wife.
The hospital charged us $275 per visit for the lactation consultant. So aproximately 15 minutes of poor guidance cost us $1650 (before insurance) while over an hour of quality guidance outside the hospital was free.
When my second was born, we made it very clear that a lactation consultant was not to come near our room for fear of being overcharged.
I would be a little careful about pointing at individuals (OB or lactation consultant) as the evil ones here. In many situations, they're overworked and understaffed and can only spend so much time with each patient. In addition, they have no idea about their own cost and likely see a merger percentage of it.
The problem typically is rooted in the profit incentive driving healthcare these days.
While some of this is eye opening (especially as I'm 7 weeks away from our first's due date) some of it isn't inherently related to childbirth and is part of a much larger scale medical issue in the USA.
Best healthcare system in the world.
Quote from: Galway Eagle on July 15, 2024, 09:10:03 AM
While some of this is eye opening (especially as I'm 7 weeks away from our first's due date) some of it isn't inherently related to childbirth and is part of a much larger scale medical issue in the USA.
Yes, for-profit health care is problematic.
Great news about your impending family addition. Congrats!
The line items are nuts. We got charged like $450 for the nurse to take our second kid to the nursery so we could get a couple hours of sleep. Most expensive babysitter ever.
It's insane how expensive the years from conception to kindergarten are. Prenatal care, birth and recovery, all the doctor visits, and oh yeah, daycare costs an arm and a leg.
I adore my kids and can't imagine life without them. But we're not exactly incentivizing people to have more of them, and I can understand why people make the decision not to.
Quote from: MUfan12 on July 15, 2024, 09:49:45 AM
The line items are nuts. We got charged like $450 for the nurse to take our second kid to the nursery so we could get a couple hours of sleep. Most expensive babysitter ever.
It's insane how expensive the years from conception to kindergarten are. Prenatal care, birth and recovery, all the doctor visits, and oh yeah, daycare costs an arm and a leg.
I adore my kids and can't imagine life without them. But we're not exactly incentivizing people to have more of them, and I can understand why people make the decision not to.
It's not just childbirth. Raising children is an increasingly expensive proposition, so there is no wonder why birthrates are declining.
Capitalism!!! Embrace it and enjoy its bountiful rewards.
Quit whining like a bunch of anti-American socialists.
Quote from: jesmu84 on July 15, 2024, 09:08:45 AM
I would be a little careful about pointing at individuals (OB or lactation consultant) as the evil ones here. In many situations, they're overworked and understaffed and can only spend so much time with each patient. In addition, they have no idea about their own cost and likely see a merger percentage of it.
The problem typically is rooted in the profit incentive driving healthcare these days.
I didn't mean to imply that they were evil in any way. I know they don't set the prices. I do question that one lactation consultant's competence but that can be the result of being overworked. Considering we saw the same one each time over multiple days i assume she's the only one in that particular hospital.
Quote from: TAMU, Knower of Ball on July 15, 2024, 10:55:53 AM
I didn't mean to imply that they were evil in any way. I know they don't set the prices. I do question that one lactation consultant's competence but that can be the result of being overworked. Considering we saw the same one each time over multiple days i assume she's the only one in that particular hospital.
Yea. Obviously competency would be a different conversation.
I was responding to the thread topic that seemed to be focused on costs.
Rule number 1 of Hospital Stays... Get out as soon as possible 8-)
Quote from: The Hippie Satan of Hyperbole on July 15, 2024, 09:52:07 AM
It's not just childbirth. Raising children is an increasingly expensive proposition, so there is no wonder why birthrates are declining.
Inflation's a bitch, a'ina?
It isn't just childbirth.
A few years ago, I went in for highly intricate and complex back surgery. It was successful but the all-in bill was about $800,000, list.
My insurance company at the time negotiated the cost down to $170,000, which was the agreed-on price between the insurance company and the hospital organization and various other providers. I was shocked at the magnitude of the reduction so I wrote the hospital administration and contended they were either committing accounting fraud or preying on the most vulnerable of society -- the uninsured.
They didn't like my letter and blamed bad deals with insurance companies for the magnitude of the markdown. Not a word about why healthcare costs were ridiculously out of control.
Quote from: dgies9156 on July 16, 2024, 11:15:03 AM
It isn't just childbirth.
A few years ago, I went in for highly intricate and complex back surgery. It was successful but the all-in bill was about $800,000, list.
My insurance company at the time negotiated the cost down to $170,000, which was the agreed-on price between the insurance company and the hospital organization and various other providers. I was shocked at the magnitude of the reduction so I wrote the hospital administration and contended they were either committing accounting fraud or preying on the most vulnerable of society -- the uninsured.
They didn't like my letter and blamed bad deals with insurance companies for the magnitude of the markdown. Not a word about why healthcare costs were ridiculously out of control.
Most uninsured don't pay anywhere close to the list price. A lot of studies show they actually pay less than the negotiated rate.
https://publichealth.jhu.edu/2023/study-finds-hospitals-cash-prices-for-uninsured-often-lower-than-insurer-negotiated-prices
The list price on a medical procedure is roughly like the list tuition price in private higher education.
Medical billing is a fiction. Except ambulance companies: they get paid close to dollar one.
Quote from: Sir Lawrence on July 16, 2024, 12:27:05 PM
Medical billing is a fiction. Except ambulance companies: they get paid close to dollar one.
And refuse to negotiate preferred rates.
Quote from: Sir Lawrence on July 16, 2024, 12:27:05 PM
Medical billing is a fiction.
I'm not sure that the thousands - tens of thousands? hundreds of thousands? - of people who have had wages garnished and other extreme measures taken against them to pay humongous medical bills would agree.
Quote from: MU82 on July 16, 2024, 01:44:48 PM
I'm not sure that the thousands - tens of thousands? hundreds of thousands? - of people who have had wages garnished and other extreme measures taken against them to pay humongous medical bills would agree.
They want you to pay the price they quote. Not everyone is savvy enough or has the bandwidth to ask questions and navigate the billing quagmire. Them being fairly quick to negotiate with should tell you everything you know about it.
My favorite medical billing story - my dog had an ACL surgery the same week as my MIL knee replacement surgery. The vet gave an itemized bill ahead of time to the exact penny of every thing. The hospital gave a statement ahead of time that the MIL knee replacement will cost between 10K and 50K. Months later we were still trying to determine the actual procedure cost across the seemingly 5 - 10 different bills received. It's amazing we can be precise predicting the healthcare costs of animals but not humans.
Quote from: Plaque Lives Matter! on July 16, 2024, 02:25:36 PM
They want you to pay the price they quote. Not everyone is savvy enough or has the bandwidth to ask questions and navigate the billing quagmire. Them being fairly quick to negotiate with should tell you everything you know about it.
A family friend who was a prominent back surgeon (eventually set up his own practice cause he was sick of dealing with hospital bureaucracy and was a big enough deal to call shots) used to call hospital billing "MSRP".
"Nobody should pay MSRP for a car, and nobody should pay MSRP on your hospital bill."
He's notoriously blunt and had some other choice words for both hospital administrative billing and patients who didn't ask questions about their bills in the internet age, but no need to muddy the thread with that.
Quote from: PointWarrior on July 16, 2024, 02:38:23 PM
It's amazing we can be precise predicting the healthcare costs of animals but not humans.
Wat
Quote from: MU82 on July 16, 2024, 01:44:48 PM
I'm not sure that the thousands - tens of thousands? hundreds of thousands? - of people who have had wages garnished and other extreme measures taken against them to pay humongous medical bills would agree.
What other "extreme measures?" If wages are being garnished that means a judgment has been entered. I don't think there are debtor prisons in North Carolina, but I could be mistaken. As others have mentioned, health care providers will negotiate with the patient if there is no insurance. But my point is that the actual bill is a fiction. The health care providers know that they are not going to collect what is billed.
Quote from: JWags85 on July 16, 2024, 02:41:47 PM
A family friend who was a prominent back surgeon (eventually set up his own practice cause he was sick of dealing with hospital bureaucracy and was a big enough deal to call shots) used to call hospital billing "MSRP".
"Nobody should pay MSRP for a car, and nobody should pay MSRP on your hospital bill."
He's notoriously blunt and had some other choice words for both hospital administrative billing and patients who didn't ask questions about their bills in the internet age, but no need to muddy the thread with that.
Non profit hospitals can only charge uninsured patients at most their average reimbursement rate from their in network insurance companies. Also, they are required to post their charity care policies. So many, if not most uninsured patients hospital coverage for free.
The big issue is insureds copays and deductibles, which are crazy.
Quote from: Sir Lawrence on July 16, 2024, 02:48:23 PM
What other "extreme measures?" If wages are being garnished that means a judgment has been entered. I don't think there are debtor prisons in North Carolina, but I could be mistaken. As others have mentioned, health care providers will negotiate with the patient if there is no insurance. But my point is that the actual bill is a fiction. The health care providers know that they are not going to collect what is billed.
I guess "extreme" beyond garnished wages are things like medical liens on houses - it has happened, and more than I thought when I read about it for the first time. Or medical groups graciously offer to set up payment plans that last a decade or more. Then folks had to pray that they wouldn't have another big hospital bill or other expense.
The Charlotte Observer won awards with a series they did 12 years ago about how hospital administrators, management and doctors were getting rich while low-wage regular folks were losing the few things they had. The medical group my wife worked for had 30+ administrators making at least $1M annually, even as the group went after poor people's last dollar.
I just googled the series, and this anecdote from it came up:
Rachael Shehan has no health insurance and virtually no income. But when serious respiratory problems strike, her hospital has never provided financial help, she said. Instead, the 39-year-old Lenoir resident says, Caldwell Memorial Hospital has sent bill collectors who have hounded her for payment and ruined her credit. Now, she sometimes bursts into tears when medical problems arise. 'I know the hospital isn't going to help me with my bills,'says Shehan, who relies on food stamps and the help of friends. Nonprofit hospitals such as Caldwell Memorial are exempt from property, sales and income taxes. In return, they are expected to give back to their communities, largely by providing care to those who can't afford it.Also this:
Top executives are paid millions as their hospitals expand, buy expensive technology and build aggressively. And they benefit each year from a perk worth millions: They pay no income, property or sales taxes. These institutions were created with charitable missions. But many don't act like nonprofits anymore. In their quest for growth and financial strength, they have contributed to the rising cost of health care, leaving thousands of patients with bills they struggle to pay.I do agree that the amount originally billed is "fiction." But the end result is still often all too real to the vulnerable folks who can least afford it. Those with means are rarely affected because most have good health insurance.
I'll also allow that maybe things have improved the last few years as the ACA has gotten better and more states (including NC) have expanded Medicaid.
Quote from: MU82 on July 16, 2024, 03:19:16 PM
Also this:
Top executives are paid millions as their hospitals expand, buy expensive technology and build aggressively. And they benefit each year from a perk worth millions: They pay no income, property or sales taxes. These institutions were created with charitable missions. But many don't act like nonprofits anymore. In their quest for growth and financial strength, they have contributed to the rising cost of health care, leaving thousands of patients with bills they struggle to pay.
How are non-profit health care organizations supposed to "act?"
They have to be financially viable, compete for talent, and competitively serve their exempt purpose without outside investment from owners.
Quote from: The Hippie Satan of Hyperbole on July 16, 2024, 03:33:40 PM
How are non-profit health care organizations supposed to "act?"
They have to be financially viable, compete for talent, and competitively serve their exempt purpose without outside investment from owners.
This is a pretty good read on here nonprofit health organizations are today, how they're supposed to act and how they're actually acting.
The short version ... it's a tough environment, but many focus on increasing revenues and growing footprints at the expense of their supposed and required role of serving the community interest.
https://www.nytimes.com/2023/11/30/opinion/hospitals-nonprofit-community.html
Quote from: Pakuni on July 16, 2024, 03:49:04 PM
This is a pretty good read on here nonprofit health organizations are today, how they're supposed to act and how they're actually acting.
The short version ... it's a tough environment, but many focus on increasing revenues and growing footprints at the expense of their supposed and required role of serving the community interest.
https://www.nytimes.com/2023/11/30/opinion/hospitals-nonprofit-community.html
"And in return for their tax exemptions, these institutions are supposed to invest the money that would have gone to taxes into their communities by lowering health care costs, providing community health services and free care to those unable to afford it and conducting research."
They are? Where does it say this?
Now I am not defending some of these practices. But under current IRS Code, they are not required to do any of these things. Something the GAO has acknowledged.
https://www.gao.gov/products/gao-23-106777
So the law needs to change more than anything.
Quote from: The Hippie Satan of Hyperbole on July 16, 2024, 04:02:03 PM
"And in return for their tax exemptions, these institutions are supposed to invest the money that would have gone to taxes into their communities by lowering health care costs, providing community health services and free care to those unable to afford it and conducting research."
They are? Where does it say this?
Now I am not defending some of these practices. But under current IRS Code, they are not required to do any of these things. Something the GAO has acknowledged.
https://www.gao.gov/products/gao-23-106777
So the law needs to change more than anything.
Some of the requirements, according to the link, that seem to fall under that:
- Operate an emergency room open to all, regardless of ability to pay
- Use surplus funds to improve facilities, equipment and patient care
- Use surplus funds to advance medical training, education and research
- Conduct a community health needs assessment
- Maintain a written financial assistance policy
- Set a limit on charges
- Set billing and collection limits
Quote from: Pakuni on July 16, 2024, 04:22:35 PM
Some of the requirements, according to the link, that seem to fall under that:
- Operate an emergency room open to all, regardless of ability to pay
- Use surplus funds to improve facilities, equipment and patient care
- Use surplus funds to advance medical training, education and research
- Conduct a community health needs assessment
- Maintain a written financial assistance policy
- Set a limit on charges
- Set billing and collection limits
You are misreading the chart. The requirement is the statements at the top. The list are factors that demonstrate if they are meeting that purpose. And the narrative states that:
"In 1969, the Internal Revenue Service (IRS) identified factors that can demonstrate community benefits, but they are not requirements. IRS does not have authority to specify activities hospitals must undertake and makes determinations based on facts and circumstances. As a result, tax-exempt hospitals have broad latitude to determine the community benefits they provide, but the lack of clarity creates challenges for IRS in administering tax law."
Quote from: Pakuni on July 16, 2024, 04:22:35 PM
Some of the requirements, according to the link, that seem to fall under that:
- Operate an emergency room open to all, regardless of ability to pay
- Use surplus funds to improve facilities, equipment and patient care
- Use surplus funds to advance medical training, education and research
- Conduct a community health needs assessment
- Maintain a written financial assistance policy
- Set a limit on charges
- Set billing and collection limits
1. EMTALA covers point 1
2. and 3. That is the growing footprint MU82's article seems to rail against
4. Off hand I think the community needs assesment is required every 3 years
5. The financial assistance policy must be prominently displayed as well and be available to all patients
6. "charge" limits are based onMedicare rates-DRG codes
7. Uninsured can only be billed at the average reimbursement rate nonprofits get from contracted insured , and if balances are written off, it must be the same policy for everyone
From my professional experience, the biggest problem is copays and deductibles are through the roof, as well as educating the public on their rights
Quote from: The Hippie Satan of Hyperbole on July 16, 2024, 04:29:46 PM
You are misreading the chart. The requirement is the statements at the top. The list are factors that demonstrate if they are meeting that purpose. And the narrative states that:
"In 1969, the Internal Revenue Service (IRS) identified factors that can demonstrate community benefits, but they are not requirements. IRS does not have authority to specify activities hospitals must undertake and makes determinations based on facts and circumstances. As a result, tax-exempt hospitals have broad latitude to determine the community benefits they provide, but the lack of clarity creates challenges for IRS in administering tax law."
If you dive into the testimony (PDF of it in the link you attached), it states that:
1. Nonprofit hospitals must provide a community benefit.
2. The green portion of the chart are examples of community benefits they can provide to meet the requirement.
3. The blue portion of the chart (Under Patient Protection and Affordable Care Act Requirements) are things they
must do to be tax exempt.
From the testimony, page 8
PPACA established four additional requirements that tax-exempt hospitals must meet to maintain a tax exemption
Edit: Regardless of what the chart does and doesn't say, do you agree the column I linked illustrates how the focus on growing revenues and expanding health care fiefdoms can run counter to, or at least diminish, nonprofit hospitals' purported mission of serving their community?
Here's something else worth reading:
Federal, state, and local laws exempt nonprofit hospitals from paying a variety of taxes under the assumption they will give back to their communities in commensurate amounts through patient financial assistance, primary care clinics, substance abuse treatment, and other programs. However, a new analysis using government data finds that 80% of nonprofit hospitals give back less to their communities than they receive in estimated tax breaks, with some short by hundreds of millions. https://lowninstitute.org/press-release-more-than-1900-nonprofit-hospitals-receive-more-in-tax-breaks-than-they-give-back-to-their-community-totaling-billions/
Quote from: The Hippie Satan of Hyperbole on July 16, 2024, 03:33:40 PM
How are non-profit health care organizations supposed to "act?"
They have to be financially viable, compete for talent, and competitively serve their exempt purpose without outside investment from owners.
I'm satisfied with the way others have responded, so I won't repeat what they said.
Quote from: Pakuni on July 16, 2024, 04:45:51 PM
Edit: Regardless of what the chart does and doesn't say, do you agree the column I linked illustrates how the focus on growing revenues and expanding health care fiefdoms can run counter to, or at least diminish, nonprofit hospitals' purported mission of serving their community?
Definitely.
But my larger point, and I think I am being overly-pedantic, is that there really aren't strict guidelines for how not-profit health systems are "supposed" to act. It's all very shades of gray. So, to go back to the article that MU82 quoted, the way to get hospital heath systems to be more charitable is to put it into law. Because right now, as the law is designed, they seem to be operating very much within the confines of what they are supposed to do.
Well maybe costs would go down if insurance executives stopped giving "loans" to Supreme Court justices.
One of the concerns with so-called "non-profit" hospital is that they're sliced and diced so much that who has what obligation is, at best fuzzy and at worse, obliterated.
Many communities formed tax-exempt foundations to own hospitals on grounds it was good for a community's well-being and growth to have good medical care. The hospital was truly a service. But as time moves on, the operation of the hospital is contracted to a third-party entity (Cleveland Clinic in my part of the swamp). The hospital retains its tax exempt status and has an oversight board but the day-to-day ops are done by Cleveland Clinics.
OK, so then there's the next question of who runs the operating rooms, nursing, facilities and even staff doctors. In some hospitals, all of these services are contracted out to third parties. The name on the door is nothing more than the Management Company. It's branding and operational profitability that matters.
All the while, the hospital itself is tax-free. The question is who is making the money and who pays for all these new layers of management inside the hospital? I think we know the answer!
Consolidation and corporatizing has also become a problem. In Milwaukee, your options are basically Aurora, Ascension, or Froedtert. Wheaton sold their hospitals to Ascension, which has been bad for all the hospitals involved. Further, Ascension outsourced their lab services to LabCorp, which has had a hiring freeze in place for two years while making working conditions worse, so they have slashed staff.
The focus is on the bottom line, which should never be the case when it comes to quality healthcare. The job is to care for the person, not try to give them the cheapest level of care and move them out as soon as possible. There is no such thing as "non-profit" hospitals anymore because the hospital mega corps are buying up any hospitals they can make a profit on and running the ones they can't out of business.
Quote from: brewcity77 on July 17, 2024, 09:04:39 AM
Consolidation and corporatizing has also become a problem. In Milwaukee, your options are basically Aurora, Ascension, or Froedtert. Wheaton sold their hospitals to Ascension, which has been bad for all the hospitals involved. Further, Ascension outsourced their lab services to LabCorp, which has had a hiring freeze in place for two years while making working conditions worse, so they have slashed staff.
The focus is on the bottom line, which should never be the case when it comes to quality healthcare. The job is to care for the person, not try to give them the cheapest level of care and move them out as soon as possible. There is no such thing as "non-profit" hospitals anymore because the hospital mega corps are buying up any hospitals they can make a profit on and running the ones they can't out of business.
Yep.
https://harris.uchicago.edu/news-events/news/consolidation-hospital-sector-leading-higher-health-care-costs-study-finds
My PCP left Ascension Resurrection in Chicago for a concierge practice. He gave me an earful about things when he told me, including how they were selling their hospitalists to a private company, which would result in the staff getting more patients for less money. Two days later it hit the news. In the space of about four years he went from loving his job to getting out for his own well-being and quality of life.
Quote from: Warriors4ever on July 17, 2024, 09:37:59 AM
My PCP left Ascension Resurrection in Chicago for a concierge practice. He gave me an earful about things when he told me, including how they were selling their hospitalists to a private company, which would result in the staff getting more patients for less money. Two days later it hit the news. In the space of about four years he went from loving his job to getting out for his own well-being and quality of life.
"For profit" hospitals have been outsourcing like this for decades. Ascension is trying it due to having a $3 billion operating loss FY23.
Abolish health insurance and institute a national health care system like every other first world country.
People shouldn't have their lives ruined financially because they got sick.
Quote from: Hards Alumni on July 17, 2024, 01:01:13 PM
Abolish health insurance and institute a national health care system like every other first world country.
People shouldn't have their lives ruined financially because they got sick.
Bingo. It'll never happen but this is the correct answer.
It's an economical and moralistic right thing to do
Quote from: Hards Alumni on July 17, 2024, 01:01:13 PM
Abolish health insurance and institute a national health care system like every other first world country.
People shouldn't have their lives ruined financially because they got sick.
Great ideas. but you forgot the 1st one - Get rid of for-profit hospitals.
Costs will never be low as expenses for the hospitals are huge, but they can be lowered
Quote from: Jockey on July 17, 2024, 01:19:39 PM
Great ideas. but you forgot the 1st one - Get rid of for-profit hospitals.
Costs will never be low as expenses for the hospitals are huge, but they can be lowered
I didn't forget it, it's a part of nationalizing health care.
Quote from: Hards Alumni on July 17, 2024, 01:22:16 PM
I didn't forget it, it's a part of nationalizing health care.
According to OpenSecrets website:
Individuals and PACs associated with the insurance industry made $120 million in federal contributions during the 2020 election cycle.
Quote from: lawdog77 on July 17, 2024, 01:28:38 PM
According to OpenSecrets website:
Individuals and PACs associated with the insurance industry made $120 million in federal contributions during the 2020 election cycle.
It'll never happen. Too much money involved.
Quote from: lawdog77 on July 17, 2024, 01:28:38 PM
According to OpenSecrets website:
Individuals and PACs associated with the insurance industry made $120 million in federal contributions during the 2020 election cycle.
It's amazing how easily bought and paid for our politicians are, isn't it?
Quote from: Hards Alumni on July 17, 2024, 01:39:27 PM
It's amazing how easily bought and paid for our politicians are, isn't it?
Yep. It's crazy how both presidential candiates brag about how much money they have raised.
Quote from: Hards Alumni on July 17, 2024, 01:39:27 PM
It's amazing how easily bought and paid for our politicians are, isn't it?
Don't even get me started on their lack of moral courage and leadership. Every one of them is useless.
Quote from: lawdog77 on July 17, 2024, 01:28:38 PM
According to OpenSecrets website:
Individuals and PACs associated with the insurance industry made $120 million in federal contributions during the 2020 election cycle.
Insurance companies are people just like you and me.
Quote from: Hards Alumni on July 17, 2024, 01:39:27 PM
It's amazing how easily bought and paid for our politicians are, isn't it?
Judges too
https://www.rollingstone.com/politics/politics-features/clarence-thomas-rv-loan-health-care-1235059440/ (https://www.rollingstone.com/politics/politics-features/clarence-thomas-rv-loan-health-care-1235059440/)
Quote from: lawdog77 on July 17, 2024, 02:05:19 PM
Judges too
https://www.rollingstone.com/politics/politics-features/clarence-thomas-rv-loan-health-care-1235059440/ (https://www.rollingstone.com/politics/politics-features/clarence-thomas-rv-loan-health-care-1235059440/)
He has always been open to bribes. And he's only the 2nd most corrupt justice. Combine that with the weakest Chief Justice in history and our democracy disappears if trump is elected.
Quote from: MU82 on July 15, 2024, 08:11:12 AM
From Sarah Kliff in today's NYT The Morning e-newsletter:
Americans spend more on childbirth than nearly anything else that happens at the hospital. The average delivery is $13,000. Even after insurance pays, patients who have babies still end up on the hook for nearly $3,000.
I've spent 15 years covering the high costs of American health care, an industry in which patients routinely encounter $600 Band-Aids and $3,000 Covid tests. Recently, I've been amazed at how much hospitals, doctors and medical device companies are charging families for newborn care.
They are eking out more money from each step of having a baby. They often tap into the anxiety that so many parents feel as they form new families. "People are willing to do anything to ensure the well-being of their kids even before they meet them," said Neel Shah, chief medical officer at Maven, a women's health clinic.
Health care companies have several chances to make their pitch between a positive pregnancy test and the birth of a child.
In the first trimester, genetic companies sell tests that claim to detect serious and rare problems from a few vials of the mother's blood. But these tests, which can cost thousands of dollars, are usually wrong when they make grave predictions about an infant's health. The inaccurate results can lead parents to spend thousands on more tests and even to consider abortion.
The second trimester often brings a pitch for umbilical-cord blood banking. Brochures in obstetricians' offices describe how paying to freeze and store a newborn's stem cells may be vital if the child becomes ill later in life. But the few parents who try to use their samples often find that they are unusable, either because they have too few stem cells or because they are contaminated. Azeen Ghorayshi and I investigated these companies in a story The Times published today.
Most spending on childbirth goes toward delivery and newborn care. Cesarean section delivery remains the most common surgery in American hospitals, despite years of advocacy to lessen its use. About 30 percent of kids are born this way, more than twice the World Health Organization's recommendation.
One reason is that we have bizarre incentives. Hospitals earn 50 percent more for C-sections than for vaginal deliveries, even though recent research shows they cost less than vaginal deliveries. When cheaper medical care earns more money, that warps behavior.
Neonatal intensive care is also proving to be very profitable. Nearly 40 percent more babies went to these units, supposedly reserved for the sickest kids, from 2008 to 2018. But the infants weren't sicker. Some doctors worry that hospitals may send healthy babies to the NICU because it pays better. Investors, seeing the opportunity, have been buying up neonatology practices.
The experts I talked to have a few explanations for why these efforts work. To start, there are millions of births every year. Hospitals know that childbirth will always make up a large share of their revenue.
Another reason is that the most successful messages — the case for banking cord blood, buying advanced genetic tests or spending a few extra nights in the NICU — are selling safety for your child.
Lastly, these pitches tend to come from a trusted source: our doctors. They distribute brochures that overstate the benefits of cord blood banking or genetic testing. Cord blood banks even pay obstetricians to collect the stem cells. When your doctor endorses a new and promising technology, it is awfully hard to say no.
Example from living in a non-US country which has a not great public health care system that's very low cost, and an active private health care system for those who want to pay: When you find out you are pregnant you go to a birth consultant at the hospital of your choice and pay for a "package" including all services. The cheapest packages using the public system and minimal care and no guarantee of the same doctor and normal wards are in the $250 range. The most expensive package which guarantees the same doctor throughout, covers all tests and ultrasounds and birthing and private room afterwards... and all the 'panic' visits for early contractions and bleeding and all that kinds of stuff... essentialy the top package covers everything except the conversion of the birthing process to c-section. $3000. C-section (which we had to do, that's a different story) was $1200 extra. This was for "Professor-Doctor" care throughout, from the head of the department! There was nothing about this experience that was even a tiny bit worse than a top US hospital.
The problem is not the hospitals or the doctors, it's who is paying. When there is no such thing as insurance (like the country we were in) and the user pays for the service, the user will pay the best price for themselves, and the providers must meet every possible price point. When insurance is paying and people don't even know the cost nor the revenue of the services provided, the accountability is gone, and prices go up!
From the Wall Street Journal:
Some private Medicare Advantage insurers pushed nurses to run screening tests and add unusual diagnoses that entitle the companies to extra money, a WSJ investigation found. The roughly hourlong stops turned into $1,818 more per visit, on average, from 2019 to 2021—about $15 billion in total.
Many insurer-driven diagnoses were wrong or highly questionable. Private insurers denied using inaccurate diagnoses to jack up their payments. The Medicare Payment Advisory Commission, a nonpartisan agency that advises Congress, recommended not using home-visit diagnoses toward extra payments, and the overseeing inspector general advised reconsidering using these diagnoses.
The Centers for Medicare and Medicaid Services said the agency recently increased its diagnosis audits and is making some diagnoses ineligible for extra payments.
Quote from: MU82 on August 05, 2024, 07:42:52 PM
From the Wall Street Journal:
Some private Medicare Advantage insurers pushed nurses to run screening tests and add unusual diagnoses that entitle the companies to extra money, a WSJ investigation found. The roughly hourlong stops turned into $1,818 more per visit, on average, from 2019 to 2021—about $15 billion in total.
Many insurer-driven diagnoses were wrong or highly questionable. Private insurers denied using inaccurate diagnoses to jack up their payments. The Medicare Payment Advisory Commission, a nonpartisan agency that advises Congress, recommended not using home-visit diagnoses toward extra payments, and the overseeing inspector general advised reconsidering using these diagnoses.
The Centers for Medicare and Medicaid Services said the agency recently increased its diagnosis audits and is making some diagnoses ineligible for extra payments.
We have Medicare Advantage through United Healthcare and get at least a call a week wanting to set up a home visit. My wife did it once and got a $50 gift card but after talking to my Dr, I just schedule a 6 month visit with him.