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Old 01-30-2018, 12:08 PM   #41
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I hope it is disruptive... We need some disruption in our inefficient health care system.

But - unless they follow a model like Kaiser Permanente (or the purchase of urgent care clinics mentioned in a previous post) they will only address one portion of the cost... The insurance/claims side of things. Providers are also part of the high cost.

It will be very interesting to watch what they implement.
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Old 01-30-2018, 12:15 PM   #42
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Originally Posted by Mr._Graybeard View Post
I'm no expert, but IMO malpractice insurance is a red herring as a driver of health care costs. Malpractice claims and awards have been on the decline for the past decade, in part because numerous states have placed caps on non-medical awards.

Here's an article by Dr. David Belk that has an interesting take on the subject: Medical Malpractice: Myths and Realities - True Cost of Heathcare
If you have another explanation for 20% excess testing and all the legal waivers that have to be filled out, I am all ears.

BTW, that article seemed extremely biased in the favor of lawyers.
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Old 01-30-2018, 12:16 PM   #43
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The Commonwealth Club podcasts include discussions of many current topics. The one about health care costs is dated 9/27/17 and is available on by Dr. Ezekiel Emanuel and is available on iTunes. One memorable comment, for me, was that a local hospital at which he practiced remodeled to look like a 4-star hotel, it didn't improve the already excellent medical care offered. Someone had to pay for the bling.
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Old 01-30-2018, 12:28 PM   #44
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If you have another explanation for 20% excess testing and all the legal waivers that have to be filled out, I am all ears.

BTW, that article seemed extremely biased in the favor of lawyers.
Here’s an article by Doctors (JAMA), as opposed to Lawyers. It cites a widely used estimate for the annual cost of waste due to defensive medicine ($46B), which aligns with the estimate in the video of my earlier post, and is very small compared to other causes.

The “Doctors” conclude:

In conclusion, although a large portion of hospital orders had some defensive component, our study found that few orders were completely defensive and that physicians’ attitudes about defensive medicine did not correlate with cost. Our findings suggest that only a small portion of medical costs might be reduced by tort reform.

https://jamanetwork.com/journals/jam...rticle/1904758
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Old 01-30-2018, 12:33 PM   #45
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Weren't there already rumblings about Amazon getting into the pharmacy business. This may be a precursor.
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Old 01-30-2018, 12:38 PM   #46
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This has been working for a while and Amazon , Warren and Jamie Dimon are not the only ones . The big hospitals have been working on this . This will get rid of health insurance on the day to day problems. My son is in the medical industry and if I understand correctly if you are a doctor and do not become part of one ofthese groups you will be pretty much gone . And as a patient your insurance will go away , also you will become part of a group. Health insurance companies add no value to anything . The hard problem is insurance companies are invested in everything and this could be a disaster in the short economy.
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Old 01-30-2018, 12:43 PM   #47
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If you have another explanation for 20% excess testing and all the legal waivers that have to be filled out, I am all ears.
How about: the hospitals have lots of high-cost toys they have to keep running steadily to justify the investment in them?
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Old 01-30-2018, 01:20 PM   #48
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Yes I have heard about the machines that do CT scans in Houston Texas . I have heard we have so many and they do not have the patients to pay them off so they must increase the prices . Instead of having maybe less and running them 24 / 7 similar to Europe or Canada.
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Old 01-30-2018, 02:02 PM   #49
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How about: the hospitals have lots of high-cost toys they have to keep running steadily to justify the investment in them?
This is true and also a indication that there is probably significant over-investment in the industry, which is economically wasteful.

Hospitals are in the business of revenue generation. The disassociation of pricing and cost is a worrying sign. Stripping cost out of provider services may not lead to lower prices, just higher net incomes for the hospitals. Cost control by the hospitals won't work, it must be done on them and other providers.

From Census, BLS and KFF data, the average premium for employer paid group coverage is >$15K, and median household income is $55K. Business can no longer afford this, neither can any family below the 70% income percentile. The high cost of health care is one of the biggest challenges to economic growth in the US.

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I’m in favor of smart people (with lots of resources) trying to solve problems.
Yes indeed, and these three companies have some very smart people. This has lots of potential.
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Old 01-30-2018, 02:08 PM   #50
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Weren't there already rumblings about Amazon getting into the pharmacy business. This may be a precursor.
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Old 01-30-2018, 02:22 PM   #51
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This is true and also a indication that there is probably significant over-investment in the industry, which is economically wasteful.
In my area there are two large, multi-hospital medical groups that dominate the most affluent suburbs in the metro region.

About 10 years ago, the larger of the two groups decided to build a new hospital in a town near me, despite the fact that the smaller group already has a hospital there. So we now have two full-service hospitals in a city of 15,000.

Of course, with a new, 800,000 square foot medical center on its turf, the older hospital had to undergo some extensive upgrades so it could compete with the new guy on every level.
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Old 01-30-2018, 02:22 PM   #52
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Can you just imagine , Jeff Bezos , Warren Buffet and Jamie Dimon . These three gentlemen control over 1.5 million employees and this is where it is starting . Total those 1.5 million employees leaving the insurance pool . Healthcare is dragging the market down today with this news.
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Old 01-30-2018, 02:31 PM   #53
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I'm no expert, but IMO malpractice insurance is a red herring as a driver of health care costs. Malpractice claims and awards have been on the decline for the past decade, in part because numerous states have placed caps on non-medical awards.

Here's an article by Dr. David Belk that has an interesting take on the subject: Medical Malpractice: Myths and Realities - True Cost of Heathcare
A couple of things to point out by reading the link you provided:

FIRST - Malpractice insurance costs vary SIGNIFICANTLY by state and by area of practice. The example in your link doesn't show where the doctor practices, or his area of practice. However, as the link below illustrates, the cost for general practice (e.g. internal medicine) is can be as low as $3,300 (Minnesota) and as high as $47,000 (Florida). For those same states, the premium cost for general surgeon runs as low as $11,300 (Minnesota) to $190,000 (Florida). Then also look at why OBGYN pays, $16,000 (Minnesota) and $190,000 (Florida). So the example shown in your link is hardly representative of costs for Doctors as a whole.

How Much Does Medical Malpractice Insurance Cost?

The same article mentions that in 2015 there were $9.7B spent for writing malpractice policies (that compares with $7.6B spent in 2000). The article does mention that this is about 1% of total health care costs, but when you consider that most health care is for routine exams, I'd guess (just my guess) that most of the claims are for more invasive type of procedures - those where one sees a significant type of charge for malpractice insurance (surgery and OBGYN).

SECOND - AND MORE IMPORTANTLY - As stated in the link you provided there's an implied cost due to malpractice that isn't directly in the cost of malpractice, the cost of defensive medicine. This is the cost where doctors now are so concerned with malpractice lawsuit that they order many tests.
Quote:
Many have countered that fact by saying that doctors are so terrified of being sued they’ll often order batteries of unnecessary tests on patients and make unnecessary referrals in order to avoid lawsuits. It’s these unnecessary tests that drive up our health care costs, not the direct cost of medical malpractice.
According to the information in the link you provided that runs $650-850 BILLION per year. BCBS estimated the costs to be only $45 BILLION. Whatever the cost is, it needs to be factored in when considering the cost of malpractice.
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Old 01-30-2018, 02:54 PM   #54
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Curious if after jumping through all the hoops for your Wellness plan if you felt you actually achieved a better level of health. My former employer had similar plan (hint, my former employer is one of these companies). Yes, I went through the horse and pony show for getting my Wellness credits, but honestly, in the end, I was no healthier. After years of basically the same 'education' I was no more health smarter. I felt it was just a way for them to increase rates, let those who were too lazy or had more than enough money pay the higher rates, and those who were more financially concerned jump through the hoops in order to save some money.

I kid you not my co-worker logs and counts her hours she spends reading books as HI workouts. If reading a book is high intensity workout, I should look like the Rock by now after all this ER reading I do lol

My Healthcare ETF took a beating on this news. But it'll be back. Look how hard it was to decouple ACA.
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Old 01-30-2018, 03:20 PM   #55
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Originally Posted by bobandsherry View Post
A couple of things to point out by reading the link you provided:

FIRST - Malpractice insurance costs vary SIGNIFICANTLY by state and by area of practice. The example in your link doesn't show where the doctor practices, or his area of practice. However, as the link below illustrates, the cost for general practice (e.g. internal medicine) is can be as low as $3,300 (Minnesota) and as high as $47,000 (Florida). For those same states, the premium cost for general surgeon runs as low as $11,300 (Minnesota) to $190,000 (Florida). Then also look at why OBGYN pays, $16,000 (Minnesota) and $190,000 (Florida). So the example shown in your link is hardly representative of costs for Doctors as a whole.

How Much Does Medical Malpractice Insurance Cost?

The same article mentions that in 2015 there were $9.7B spent for writing malpractice policies (that compares with $7.6B spent in 2000). The article does mention that this is about 1% of total health care costs, but when you consider that most health care is for routine exams, I'd guess (just my guess) that most of the claims are for more invasive type of procedures - those where one sees a significant type of charge for malpractice insurance (surgery and OBGYN).

SECOND - AND MORE IMPORTANTLY - As stated in the link you provided there's an implied cost due to malpractice that isn't directly in the cost of malpractice, the cost of defensive medicine. This is the cost where doctors now are so concerned with malpractice lawsuit that they order many tests.

According to the information in the link you provided that runs $650-850 BILLION per year. BCBS estimated the costs to be only $45 BILLION. Whatever the cost is, it needs to be factored in when considering the cost of malpractice.
Belk is an internist who practices in Alameda, Calif.

Yes, malpractice insurance varies widely by location and specialty. I'll buy that there were $9.7 billion in medical malpractice policies written nationwide in 2015.

So you're arguing that insurers were willing to take $9.7 billion to cover malpractice risk while hospitals and doctors did at least $45 billion in unnecessary tests and procedures to avoid lawsuits they were already covered against (by insurers, for $9.7 billion)? Something there doesn't compute.
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Old 01-30-2018, 03:23 PM   #56
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Can you just imagine , Jeff Bezos , Warren Buffet and Jamie Dimon . These three gentlemen control over 1.5 million employees and this is where it is starting . Total those 1.5 million employees leaving the insurance pool . Healthcare is dragging the market down today with this news.
This consortium is but a drop in the bucket to the total employer and healthcare market.

The following are from the Kaiser Family Foundation website. Numbers are based on the census: https://www.kff.org/other/state-indi...2:%22asc%22%7D

In 2016 including the March 2017 update to census data:
157.3 M in Employer Sponsored Plans about 50% of the total eligible
1.5 M in the Bezos-Buffet-Dimon consortium (.9% of all employer plans)
21.8 M in Private Non-Group plans
62.3 M in Medicaid Plans
44.5 M in Medicare Plans
6.1 M in Other public plans (Military, VA)
28.0 M are Uninsured
320.3 M Grand Total per the census data
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Old 01-30-2018, 03:53 PM   #57
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Belk is an internist who practices in Alameda, Calif.

Yes, malpractice insurance varies widely by location and specialty. I'll buy that there were $9.7 billion in medical malpractice policies written nationwide in 2015.

So you're arguing that insurers were willing to take $9.7 billion to cover malpractice risk while hospitals and doctors did at least $45 billion in unnecessary tests and procedures to avoid lawsuits they were already covered against (by insurers, for $9.7 billion)? Something there doesn't compute.
Not arguing anything, just shared details are reported. But I agree that something doesn't compute, just differ on what it might be.
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Good Healthcare Reference Material
Old 01-30-2018, 04:44 PM   #58
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Good Healthcare Reference Material

The “Frontline” video below (although a bit dated - 2008) is excellent and still very relevant to all the threads discussing ‘how to improve the US’s healthcare system.’

I’d searched for it a few weeks ago (for another E-R.org thread) but, didn’t find it until now. Regardless of where you stand in this debate, it’s well worth the ~1 hour it takes to watch it. For those who can’t spend that much time, I’ve summarized key information below.

https://www.pbs.org/wgbh/frontline/f...roundtheworld/

——————
Lessons from First World Health Care Systems:

Some key characteristics of the healthcare systems in the countries examined, along with (Healthcare Spending/Capita; WHO Health System Ranking*):
1. Britain($4,003pp; #18): Universal Care, Managed Care (Gate Keeper), Government Operated, Competition Among Providers
2. Japan($4,150pp; #10): Mandatory Coverage, Overwhelmingly Private, Unlimited Access, Price Controls, Competition Among Providers
3. Germany($5,267pp: #25): Universal Coverage, Mostly Private Providers & Insurance Thru Employer, Competition Among Providers, Standard Prices Negotiated Privately on a National/State Level
4. Taiwan($1,166pp; #2**): Universal & Mandatory Coverage, No Managed Care, No Waiting Times, Modern Admin/IT System, relatively new (1990s)
5. Switzerland($6,935pp; #20): Universal & Mandatory Coverage, Competition Among Providers, relatively new (1994)
==>USA: ($9,451pp; #37)

*May vary slightly by year.
**Difficult to find; sourced from different international index (Note: calculating it myself from raw data, I get $1,397pp so, it’s close.)

Also, all five countries examined have: universal coverage, no pre-existing conditions exclusions, mandatory coverage, better health care outcomes, significantly lower cost, no personal bankruptcy due to medical bills, higher citizen/patient satisfaction.

The journalist’s Three Take Aways to consider for improving US healthcare were:
1. Universal Coverage
2. Mandatory Sign-Up
3. Standard Pricing

——————
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Old 01-30-2018, 04:53 PM   #59
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How about: the hospitals have lots of high-cost toys they have to keep running steadily to justify the investment in them?
I think that is, indeed, part of the problem. You see the same type of problem at the colleges. The kids all want the best facilities so that is where they go and the prices go up accordingly. All the colleges I visited with my kids were in a construction boom and that was 2009.
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Old 01-30-2018, 05:37 PM   #60
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Yes I have heard about the machines that do CT scans in Houston Texas . I have heard we have so many and they do not have the patients to pay them off so they must increase the prices . Instead of having maybe less and running them 24 / 7 similar to Europe or Canada.
Our massage person, lives in the UP is a Canadian citizen and has the Canadian Health Plan. She remarked one time about being tired as she a scan of something at like 2AM.

I wished her well in her recovery, but she told me it wasn't for an emergency situation, it was part of how they were utilizing the equipement 24 hours a day.

Apparently the Canadian system will refer to the hospital here for somethings if things are getting overly booked there. Seems like a reasonable way to do things.
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