Health Care Discussion

[karavotsos]

Injury from patting himself on the back. 

I just read the entire thread in one sitting and got to that post like it was a punchline.  That was outstanding.  Also, JFB rules.  Enjoy the double-dipped Thibs.

[BME to MD]

Why is the mid-60s relevant?

Chemotherapy
Radiation Cancer Therapy
Organ Transplantation (Heart, Liver, Lung, Kidney)
Artificial Hearts and Cardiac Assist Devices
ECMO
Modern Burn Surgery
Vasopressors
Statins
Long Term Ventilator Care
Modern Critical Care
Laparoscopic Surgery
Robotic Surgery
Emergence of HIV
Immunopharmacology
Joint Replacement
Dialysis
Pacemakers and Implantable Defribrillators
Modern CPR and Cardiac Arrest Care
Angioplasty
Advanced Antibiotics
Dozens of Vaccines
MRI
CT
PET
Recombinant Pharmaceuticals
tPA

All of the above were developed during or after the 1960s.  This list goes on and on because the real change in the cost curve is that we have more people surviving longer and diverse, expensive treatment options.

[dwaderoy2004]

I think the people with high deductible, HSA type plans just have a much greater disincentive to go to the doctor compared to someone on government care. If I have to pay the entire freight of a checkup (and I usually do), it makes me less willing to go compared to someone who has to pay little or nothing per visit.

The flip side to this is that if we discourage people from going to get health care when the problem is minor (and cheap to treat), said problem could develop into something that is major (and expensive to treat).

[warriorchick]

The flip side to this is that if we discourage people from going to get health care when the problem is minor (and cheap to treat), said problem could develop into something that is major (and expensive to treat).

I never understood why more medical plans aren't set up so that  preventative care is free or low cost. Most dental insurance plans are run that way (cleanings and checkups are free).  My company also has a wellness plan where if you don't maintain a healthy lifestyle (smoke, or fail to properly treat your Type II diabetes or high blood pressure), your payroll deduction for health insurance is significantly higher.

[ChicosBailBonds]

I never understood why more medical plans aren't set up so that  preventative care is free or low cost. Most dental insurance plans are run that way (cleanings and checkups are free).  My company also has a wellness plan where if you don't maintain a healthy lifestyle (smoke, or fail to properly treat your Type II diabetes or high blood pressure), your payroll deduction for health insurance is significantly higher.

Cleanings and checkups are free?  Damn, I need your dental plan.  They aren't free for us...and of course nothing is "free" anyway, someone has to pay for the time of Hygientist, the xrays, etc

[ChicosBailBonds]

Injury from patting himself on the back. 

All the times you asked me to mildly spank you on your behind.

[mu03eng]

It was originally directed at Victor, but anyone that advocates for a single payer system is free to answer.  What about single payer will improve out current system from where it is.  If we all acknowledge it has the most innovative and advanced capabilities, what about single payer will allow that to continue while bending the cost curve?

[Coleman]

What about single payer will improve out current system from where it is.

Honestly, Google it. I'm not going to explain every facet of a single payer health system to you. Our country has been having this debate for 3 years.

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

[Coleman]

I never understood why more medical plans aren't set up so that  preventative care is free or low cost. Most dental insurance plans are run that way (cleanings and checkups are free).  My company also has a wellness plan where if you don't maintain a healthy lifestyle (smoke, or fail to properly treat your Type II diabetes or high blood pressure), your payroll deduction for health insurance is significantly higher.

Medical plans are set up that way. Its the law.

That is the basis of the ACA. All insurance plans are required to have free preventative care with no copay. Its actually quite a bit of services that are included.

http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html

[ChicosBailBonds]

When they address tort reform (serious tort reform), I'm all ears. 

[WellsstreetWanderer]

If single payor is so great why did  it have to be  passed without being read or commented on?  And why aren't Pols included in this great coverage?
And Chico's, 30 years of being involved with start-up medical companies allows me to comment on Tort reform: If people knew how much the spector of bogus law suits adds to the cost of medicine, they would revolt. example: the phony science that caused 3 Billion dollars to be taken from manufacturers of silicon breast implants. years later a 10,000 nurse study showed silicon to be the inert material we all knew it was.

[ChicosBailBonds]

If single payor is so great why did  it have to be  passed without being read or commented on?  And why aren't Pols included in this great coverage?
And Chico's, 30 years of being involved with start-up medical companies allows me to comment on Tort reform: If people knew how much the spector of bogus law suits adds to the cost of medicine, they would revolt. example: the phony science that caused 3 Billion dollars to be taken from manufacturers of silicon breast implants. years later a 10,000 nurse study showed silicon to be the inert material we all knew it was.

I have no doubt...and I love bringing up the breast implant faux story as well.  Crazy.  Almost destroyed the industry just as General Aviation was essentially destroyed due to liability issues, etc. 

[mu03eng]

Honestly, Google it. I'm not going to explain every facet of a single payer health system to you. Our country has been having this debate for 3 years.

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

Oh I understand single payer healthcare just fine, but I want you to articulate for me what single payer will do to bend the cost curve without sacrificing innovation and capabilities.  If you can't then why should we do it?

[Hards Alumni]

If single payor is so great why did  it have to be  passed without being read or commented on?  And why aren't Pols included in this great coverage?
And Chico's, 30 years of being involved with start-up medical companies allows me to comment on Tort reform: If people knew how much the spector of bogus law suits adds to the cost of medicine, they would revolt. example: the phony science that caused 3 Billion dollars to be taken from manufacturers of silicon breast implants. years later a 10,000 nurse study showed silicon to be the inert material we all knew it was.

Single payer wasn't passed.  Nor was it ever introduced.

[Badgerhater]

Medical plans are set up that way. Its the law.

That is the basis of the ACA. All insurance plans are required to have free preventative care with no copay. Its actually quite a bit of services that are included.

http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html

No such thing as free.   Someone else gets to pay for you.

[muwarrior69]

Not sure about that.  Yes, Uncle Sam subsidizes health care, but Medicare/Medicaid rates are far below what the market charges .. so much so, that many providers refuse to take those patients.  The ACA has only affected health care costs over the past couple years since it passed.  The trend in increases has been going for 10-15 years prior.  Why?  Because we keep inventing new and costly ways of keeping people alive, and no one wants to die or feel sick.  Add in an unhealthy populace and an increasing life expectancy .. big problems.

Yep! My wife and are retired and when we went on Medicare to our surprise our Doctor did no take Medicare.  I went on the Medicare provider web site and the first ten I called though they accept Medicare do not take new Medicare patients. We had to go to a concierge practice. We pay the doctor 3000 a year just to be our doctor. Must say the I am getting good quality care and worth the price. He actually spends much more time with you as their practice is limited to 500 patients. Just a note... I go each month for a B12 injection for pernicious anemia. He bills Medicare 15 dollars. I pay nothing, but he only get 45 cents back from Medicare and my co-insurance. No wonder doctors are not taking new Medicare patients...they would go out of business in a hearbeat.

[muwarrior69]

I was watching C-Span and a spokes person for the administration was explaining that families of 4 that earn around 30-40k per year would get a  subsidy up to about 11k a year if they got their coverage through the exchanges designated in the ACA. A family in that category would also not pay more than 2% of gross income for their premium. Well our medicare, co-insurance and part D insurance runs us about 7200 per year. If you add in the 3k we pay for our concierge doctor and 5.5 K Long Term Health insurance my wife and I are paying about 18% of our income at present for health coverage. I would like to know where is our subsidy since we are retired and on a fixed income. I guess at 74K a year we are considered wealthy. And to add insult to injury our Social Security is taxed as income. I can't imagine how much more the government is going to squeeze out from us once we start taking distributions on our 401ks which will dramatically increase our income. It's my understanding that our Medicare premium will increase from the 228 per month to 500 next year. So I guess you know who is paying for all that "free" preventive care in the ACA. It's we seniors.

[warriorchick]

I was watching C-Span and a spokes person for the administration was explaining that families of 4 that earn around 30-40k per year would get a  subsidy up to about 11k a year if they got their coverage through the exchanges designated in the ACA. A family in that category would also not pay more than 2% of gross income for their premium. Well our medicare, co-insurance and part D insurance runs us about 7200 per year. If you add in the 3k we pay for our concierge doctor and 5.5 K Long Term Health insurance my wife and I are paying about 18% of our income at present for health coverage. I would like to know where is our subsidy since we are retired and on a fixed income. I guess at 74K a year we are considered wealthy. And to add insult to injury our Social Security is taxed as income. I can't imagine how much more the government is going to squeeze out from us once we start taking distributions on our 401ks which will dramatically increase our income. It's my understanding that our Medicare premium will increase from the 228 per month to 500 next year. So I guess you know who is paying for all that "free" preventive care in the ACA. It's we seniors.

Here is the real question: Where is the $11K of subsidy that goes to the family who makes $40K coming from?  $40K is pretty darn close to the median family income, so multiply 11K times about half the number of families in the US?  You are closing in on a trillion dollars - A YEAR.

[muwarrior69]

Here is the real question: Where is the $11K of subsidy that goes to the family who makes $40K coming from?  $40K is pretty darn close to the median family income, so multiply 11K times about half the number of families in the US?  You are closing in on a trillion dollars - A YEAR.

I forgot the good part. Families that earn up to 92K per year that get coverage through the exchanges will also be eligible for a subsidy, albeit considerably less than 11K but still eligible.

[mu_hilltopper]

So I guess you know who is paying for all that "free" preventive care in the ACA. It's we seniors.

Yeahhhh .. gentle reminder?  It's the seniors who use way more of the health care dollars in the country.  

At age 60, the per capita spending on health care rockets upward.  In macro terms, the young are subsidizing the old.

Not to say that's wrong to perform generational wealth shifting, but the idea that seniors are "paying for all that 'free' preventive care in the ACA" is entirely false.

[reinko]

With so much talk about controlling costs, how can we when some hospitals charge $30,000 more than another for the same operation.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-hospital-charges-8000-another-38000/?hpid=z1

[warriorchick]

With so much talk about controlling costs, how can we when some hospitals charge $30,000 more than another for the same operation.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-hospital-charges-8000-another-38000/?hpid=z1

I am guessing these are list prices and are meaningless.  If you ever read an EOB from your healthcare provider, you would know that the negotiated prices are 40%-80% lower.  Sometimes it's more than that.  jsglow recently received a bill on which the original charge was $880. Our insurance company's negotiated rate was $90.

And if your insurance company allows you to receive treatment at a hospital that charges that much more and then pays the bill, you are being insured by a very poorly run company.

Notice that the article is comparing bills for the same procedure that were submitted to Medicare. It didn't say Medicare paid the entire amount.  And if your provider doesn't accept Medicare assignment and you don't have supplemental insurance, shame on you for not shopping around.

[reinko]

I am guessing these are list prices and are meaningless.  If you ever read an EOB from your healthcare provider, you would know that the negotiated prices are 40%-80% lower.  Sometimes it's more than that.  jsglow recently received a bill on which the original charge was $880. Our insurance company's negotiated rate was $90.

And if your insurance company allows you to receive treatment at a hospital that charges that much more and then pays the bill, you are being insured by a very poorly run company.

Notice that the article is comparing bills for the same procedure that were submitted to Medicare. It didn't say Medicare paid the entire amount.  And if your provider doesn't accept Medicare assignment and you don't have supplemental insurance, shame on you for not shopping around.

I did read the article, and yes these are submitted prices, and yes they talk that they get negotiated down...but if different hospitals have different negotiating start points for prices, obviously, you are incentivitized to start at the highest point possible, giving yourself the best chance to have the highest amount paid by Medicare.

Shouldn't a CATscan cost (roughly 10-15%) the same thing across the country?

[muwarrior69]

Yeahhhh .. gentle reminder?  It's the seniors who use way more of the health care dollars in the country.  

At age 60, the per capita spending on health care rockets upward.  In macro terms, the young are subsidizing the old.
Not to say that's wrong to perform generational wealth shifting, but the idea that seniors are "paying for all that 'free' preventive care in the ACA" is entirely false.

Like I said above a family whose income is 40K will pay no more than 2% of their income about 800 dollars a year. My wife and I are paying 7200 a year. So who is subsidizing who...it's folks like my wife and I.

[Spotcheck Billy]

Shouldn't a CATscan cost (roughly 10-15%) the same thing across the country?

The company I work for uses a benefits broker, a few years ago he talked to us about controlling costs and mentioned as as example that medical costs in SE Wisc. are among the highest because of all of the facilities here. In particular he mentioned MRI's being high because there are more MRI machines here than in the entire province of Ontario (or something to that affect). It's about ROI.