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Old 02-25-2013, 11:48 AM   #81
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Uh huh.

Yes, though I think it is as much a matter of differing priorities as lack of understanding.
$8000 a year per American buys a lot of "lack of understanding".
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Old 02-25-2013, 11:51 AM   #82
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The amount spent per capital on health care "buys" "lack"?

Interesting hypothesis.
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Old 02-25-2013, 12:12 PM   #83
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Originally Posted by DFW_M5
I suspect the patients who are ultimately bearing the costs for these services have the will but not the leverage to do anything about it.
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I wouldn't be so sure. It sounds good when expressed as "lowering your prices" but not so good when expressed as "imposing drastic pay cuts on those angels willing to be nurses" and "big brother interfering in business' right to make profit".
I am not sure what your point is, but if you believe healthcare consumers alone have the leverage to bring down runaway healthcare costs, I don't agree with that premise.
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Old 02-25-2013, 12:20 PM   #84
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The whole system is crazy. My internist thinks it's crazy. All the doctors have to employ people whose entire job is arguing about payments, with insurance companies.
Harvard study estimated at least 1/4 of total spending on health care was for administration overhead, specifically dealing with insurance claims.

The coding system wasn't standardized so there had to be specialists and doctors had to employ people just to deal with the insurance. Or spend a lot of their own time handling it.
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Old 02-25-2013, 12:23 PM   #85
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i have been reading this thread with amusement. most people have hospital stays that are paid by insurance.

the hospital bills a gigantic amount. the insurance company says the contracted price is 20 percent of total bill. and that all the hospital gets, and covered person owes no more.


the hospital bills that ridiculous price to make sure they get every cent possible.
Would be interesting to compare profits of hospitals or doctor compensation across the OECD countries. We know the total spending is much higher for the US but it would be interesting to know the components of that.

Of course, if they can pour billions into lobbying, you kind of have an idea of their profitability.
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Old 02-25-2013, 01:14 PM   #86
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Would be interesting to compare profits of hospitals or doctor compensation across the OECD countries. We know the total spending is much higher for the US but it would be interesting to know the components of that.

Of course, if they can pour billions into lobbying, you kind of have an idea of their profitability.
Just Google to see lots...
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Old 02-25-2013, 01:38 PM   #87
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I am not sure what your point is, but if you believe healthcare consumers alone have the leverage to bring down runaway healthcare costs, I don't agree with that premise.
My point was quite the opposite - that they don't have the will, either, for the reason I specified.
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Old 02-25-2013, 01:50 PM   #88
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The United States is consistently ranked high in just about every category that could send someone to the doctor. Obesity, gun crimes, heart disease, depression, auto accidents, cancer, etc,etc. You want to cut hospital and doctor profits? Eat a salad now and then.
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Old 02-25-2013, 02:03 PM   #89
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My point was quite the opposite - that they don't have the will, either, for the reason I specified.
America isn't of a single mind.

To Cut Health-Care Costs, Pay Doctors Less - Bloomberg

https://www.ncbi.nlm.nih.gov/pubmed/12757275
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Old 02-25-2013, 02:07 PM   #90
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America isn't of a single mind.
Definitely; more to the point, acting as a voting populace, America doesn't have the collective will.
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Old 02-25-2013, 02:09 PM   #91
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The United States is consistently ranked high in just about every category that could send someone to the doctor. Obesity, gun crimes, heart disease, depression, auto accidents, cancer, etc,etc. You want to cut hospital and doctor profits? Eat a salad now and then.
This, too, but there's NO doubt that American doctors make more than their peers in other OECD countries where they have universal access and pay less per capita for equivalent health care.

If you think that doesn't have any effect, well, I don't know what to tell you.

Add in non-profit hospital profits and health insurance profits and we have a lot of people eating at the $8000/person trough. Including our obese selves.
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Old 02-25-2013, 02:13 PM   #92
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$8000 a year per American buys a lot of "lack of understanding".
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The amount spent per capital on health care "buys" "lack"?

Interesting hypothesis.
My point is that there is a huge incentive for those benefiting most from the current system to keep thorough analysis from driving real reform.

Think about it - 20% of the largest economy in the world and after all this time we can only sit around and speculate about where the money goes and how it could be made more effective. I know that they say don't suspect malice when ignorance can explain something, but I suspect malice.
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Old 02-25-2013, 02:26 PM   #93
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This one page article in Slate commenting on the Brill article is a better use of time than reading the original, IMHO:

http://www.slate.com/blogs/moneybox/...al_prices.html
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Old 02-25-2013, 02:26 PM   #94
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I wouldn't be so sure. It sounds good when expressed as "lowering your prices" but not so good when expressed as "imposing drastic pay cuts on those angels willing to be nurses" and "big brother interfering in business' right to make profit".
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My point was quite the opposite - that they don't have the will, either, for the reason I specified.
Oh, I do not see where getting our healthcare costs under control has anything to do with lack of will or the need to impose draconian cuts to Drs and nurses and I doubt most American's see it that way. Now in terms of insurance and drug companies profitability thats a different matter, and I do not believe many average American's will shed a tear over cost controls being imposed on them other than the lobbyists
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Old 02-25-2013, 02:27 PM   #95
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If only all medical procedures were elective and one could take one's time to shop around for them.
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Without belaboring the point unduly, I think it is clear that those areas don't really compare to the many factors that make the healthcare market different from other markets.
Well, they do have some applicability: Many medical procedures ARE elective. More significantly, is it just a coincidence that the only medical care services that are decreasing in cost are ones subject to the most direct market forces? That's worth thinking about--how can we apply this more broadly?

That's why I wrote this:
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These are encouraging cases of a decrease in direct health care costs, but they don't in themselves demonstrate the even bigger benefits of allowing consumers to shop not just for medical services but for medical insurance. When they can do that we'll see decreases in the even more important factors that drive up the cost of medical care in the US (e.g. failure to coordinate care, rewarding excessive procedures rather than improvements to patient health, etc)
Being able to shop for procedures (with transparent pricing,etc as we have for LASIK, etc) is an important thing, but not nearly so important as being able to shop for what we call "insurance" but is really bundled health care services. What if people could take their own money (supplemented by govt if that's our national priority) and choose from a menu of packages (HMOs, PPOs, fee for service options, Accountable Care Organizations, Patient-Centered Medical Home model, etc) under a community-rated pricing model (i.e. no one turned down, no underwriting). The marketplace needs to be efficient (i.e. customer education through easily interpreted outcome data and customer satisfaction data, wait time data, etc), the product features should be presented in a standardized format to facilitate comparisons for price, completeness, and quality.
When we apply market principles in this way to buy health care in advance (not, as I said earlier, comparison shopping for an MRI when you are bleeding), then the emphasis will be where it needs to be and costs will be bounded by supply and demand. No need for top down cost controls (which always result in artificial scarcity). No need for the very wasteful single-payer fee-for-service model (Medicare, etc).

We have not tried this.
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Old 02-25-2013, 02:33 PM   #96
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The core issue is price control: since Medicare pays too little, health care providers make it up via overpricing elsewhere. If/when underpricing is forced more widely, the usual consequence will soon follow: supply shortage.
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Old 02-25-2013, 03:24 PM   #97
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This, too, but there's NO doubt that American doctors make more than their peers in other OECD countries where they have universal access and pay less per capita for equivalent health care.

If you think that doesn't have any effect, well, I don't know what to tell you.

Add in non-profit hospital profits and health insurance profits and we have a lot of people eating at the $8000/person trough. Including our obese selves.
Perhaps I cut my list too soon. We are also number one in prescription drug use. And number one in prescription drug abuse. And number one in weird crap like autoimmune disorders. We are a country whose citizens have multiple disease processes going on at once. This leads to over utilization of specialists who have higher fees. How do you go about cutting salaries. For instance by what factor do you multiply the nurses salary to come up with the surgeons?
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Old 02-25-2013, 03:45 PM   #98
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My point is that there is a huge incentive for those benefiting most from the current system to keep thorough analysis from driving real reform.
No question, but you seem to also be implying that a thorough analysis would change the mind of enough of those currently holding to one of the strongly-held positions. I see no reason to believe that a thorough analysis will sway any significant number of people currently holding to any of the strongly-held positions. Those who adhere to the strongly-held positions would generally expect some portion of those beholden to any of the other strongly-held positions to capitulate, rather than moving from their own position.

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Think about it - 20% of the largest economy in the world and after all this time we can only sit around and speculate about where the money goes and how it could be made more effective. I know that they say don't suspect malice when ignorance can explain something, but I suspect malice.
Misjudging the "enemy" is a sure-fire way of misunderstanding the reality you face, and thereby being unable to make any progress whatsoever. Believing that one's own interpretation of the available facts will naturally rain down on others, blessing those others with the specific epiphany desired is unreasonable. People hold to strongly-held positions for good reasons - you may not choose to consider them "good", but they do, and that's all that matters. The "logical" conclusions that one might expect be derived from a "thorough analysis" are just one additional strongly-held position, not some superseding position.

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Oh, I do not see where getting our healthcare costs under control has anything to do with lack of will or the need to impose draconian cuts to Drs and nurses and I doubt most American's see it that way. Now in terms of insurance and drug companies profitability thats a different matter, and I do not believe many average American's will shed a tear over cost controls being imposed on them other than the lobbyists
We'll have to agree to disagree about that. I'll be happy to refer you to some other forums where the prospect of imposing price controls such as you suggest will be vilified in no uncertain terms, by the vast majority of the "average Americans" posting on those forums.

Reading the thread a bit further, after your message, we can see one of the opposing views, i.e., opposed to price controls, contending that price controls, applicable to some, are what actually cause higher prices for the rest, and that the right answer is no price controls at all, letting those who can afford thrive and those who cannot afford whither. There are many perspectives, and we cannot say that any of them are invalid, even if we disagree with them.
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Old 02-25-2013, 03:45 PM   #99
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Perhaps I cut my list too soon. We are also number one in prescription drug use. And number one in prescription drug abuse. And number one in weird crap like autoimmune disorders. We are a country whose citizens have multiple disease processes going on at once. This leads to over utilization of specialists who have higher fees.
I don't doubt it but read the Bloomberg article above.

"Last year, a routine visit to a U.S. doctor cost commercial insurers $89 on average, compared with $64 in Switzerland, $40 in Germany and $23 in France."

That's per visit. American doctors simply make more. Period.

"No other developed country pays doctors this much. In 2004, general practitioners in the U.S. were estimated to earn double -- measured by purchasing power -- the median for 21 nations in the Organization for Economic Cooperation and Development; for specialists, the difference was almost threefold."

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How do you go about cutting salaries. For instance by what factor do you multiply the nurses salary to come up with the surgeons?
“It’s the Prices Stupid”--Why Americans Pay More for Health Care - 2005 - Stories - News - Johns Hopkins Bloomberg School of Public Health

"OC&PA: What would it take to fix the problem?

GA: In the United States, every individual physician or hospital is negotiating the prices for health care services with insurance companies. In other countries, one agency, not necessarily a government agency, negotiates and sets the cost for all of the public and private health insurers. That gives them a much stronger negotiating entity to make deals with physicians and hospitals."


But maybe we should go after the Big Fish first.

Do American doctors get paid too much? - Slate Magazine

"But none of this really matters, because doctors' salaries aren't a large enough chunk of health care spending in the United States to make a difference. According to Reinhardt, doctors' net take-home pay (that is, income minus expenses) amounts to only about 10 percent of overall health care spending. * So if you cut that by 10 percent in the name of cost savings, you'd only save about $26 billion. That's a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors' offices, and advertising for drug companies. The real savings in health care will come from these expenses."
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Old 02-25-2013, 03:49 PM   #100
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Bread is too expensive. Clearly we should cut the pay of bakers.
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