Health care in the US

Thread Starter

ronv

Joined Nov 12, 2008
3,770
I'm going to take my wife to the Dr. today and it started me thinking about our health care system, again.
I have a few examples and I'm curious if you all have others. I know this can get political, but I think there are plenty of problems to spread around without getting into the politics.
So here is example 1.
The wife has back problems that are easily controlled with epidurals. The insurance (medicare in this case) will pay for these 4 times a year. But here is the deal. She needs to go to the primary care guy for a referral, then to the guy that does the procedure for a check (about 3 minutes) then back to him for the procedure. Now I suppose they could do an MRI each time and say "yep, you still have arthritis" or they could just let her get the treatment until it stops working. The 2 visits cost us $5 each and Medicare about $30 and $45 while the actual treatment costs us $45 and Medicare about $250 I think. Anyway, it seems like a waste of time and money to me.
Example 2:
I have an advantage plan with an on line pharmacy. I take 2 drugs. One for a thyroid condition and another for arthritis. Neither are very expensive - I think one is $20 for 90 days the other about $15 (my cost). Medicare about $70 for both. The deal is that thru the online pharmacy they are both free to me. Does that imply that the pharmacy is making $35 (or more) to fill them?
Example 3:
My wife and my friend both had colonoscopies within 2 weeks of each other at the same hospital with the same doctor. Both had Michael Jackson anesthesia. He had very good insurance at the time with GM while she was on Medicare. The cost charged to the insurance and the amount paid by the insurance was different by almost an order of magnitude. With the good insurance paying the higher amount.
Anyone with similar experiences?
PS
Would be interesting to see how this works in other countries.
 

Robin Mitchell

Joined Oct 25, 2009
819
The UK is great for medical when it comes to the NHS. Yes the treatment may not be as good nor may it be as fast but its free and works 99% of the time.
I can stroll into a hospital (or doctors), with a medical treatment and it will be fixed regardless of my funds or insurance.

Some people do get private such as my parents who pay for scans (as a check up), and also paid to get my sisters tumour out.
 

#12

Joined Nov 30, 2010
18,210
In the last 5 years the medical quality around here has become much worse. I had an excellent doctor for 20 years. He reduced the time I couldn't walk (per year) by 90%. He was squeezed out of business by lower and lower insurance payments. So, I was assigned to a random doctor by the insurance company and he went out of business 100 days later. So I was assigned to another random doctor and he couldn't measure my legs if I told him what was wrong and brought him a tape measure! The next random doctor decided to discontinue all treatments, and give me opiates. Then she played DEA games like she was trying to build a criminal case against me!:mad: After 3 months of that, I deteriorated to in-patient status, so I fired that doctor. The next random doctor was a cash flow maniac, ordering unnecessary, expensive, invasive tests and treatments, falsifying charges for tests that never happened, and still providing no treatment for me. Now, I'm with random stranger number five. The first time I met her (in December) I said I need a new left foot for my wooden leg. She arranged an appointment in February to look at the broken left foot (which I could drop off at her office in a shoe box) instead of having the sense to look at it in December.

If this is the level of intellect that qualifies for a Doctorate Degree and a State Certificate of Competency, things have changed a lot!

Consider this thing I call a "behavioral truth": Six years ago, I didn't play on the Internet because I was always busy being active and productive. Five years ago, I joined this website. I have posted over 13,000 times in five years because I couldn't be physically active.:(
 

wayneh

Joined Sep 9, 2010
16,398
The 3 examples you described are symptoms of the same problem: Americans have largely separated themselves from the purchasing process of health care. The market for health care isn't a market.

The same anomalies would arise if we decided to have someone else pay for our homes, cars or vacations. Some people would have great home, car or vacation "coverage" and not care what they spend on those items. There would be vendors with absurd prices to happily take their payments. Those same vendors would find a way to also sell to folks with lesser or no coverage, enlarging their revenues as much as possible while not selling below cost. If most folks had coverage, prices on average would be much higher. It would be a mess, just like healthcare is.

Nothing can or will fix this without bringing market forces back into play so that, every moment of every day, people shopping for and buying health care cause vendors to offer competitively priced services.
 

joeyd999

Joined Jun 6, 2011
4,410
From Ayn Rand's Atlas Shrugged:

“I quit when medicine was placed under State control some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but ‘to serve.’ That a man’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards — never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe, if he is the sort who doesn’t.”
 

#12

Joined Nov 30, 2010
18,210
From Ayn Rand's Atlas Shrugged
That was a very eloquent way to say, When the government, with one branch or another, tells physicians which treatments they are allowed to use, how many days a patient has to get well, what they can prescribe as medicine, and how much they will be paid, the only physicians left will be the ones unworthy of their profession.
 

joeyd999

Joined Jun 6, 2011
4,410
That was a very eloquent way to say, When the government, with one branch or another, tells physicians which treatments they are allowed to use, how many days a patient has to get well, what they can prescribe as medicine, and how much they will be paid, the only physicians left will be the ones unworthy of their profession.
More amazing is she wrote this in 1957.
 

dannyf

Joined Sep 13, 2015
2,197
Nothing can or will fix this without bringing market forces back into play so that, every moment of every day, people shopping for and buying health care cause vendors to offer competitively priced services.
Absolutely true.

I pay a fixed premium so that someone will pay for my healthcare expenses down the road. What healthcare services I receive have nothing to do with what I pay. So I will always choose the most expensive and most expansive services, and the more the merrier.

It is like you pay a fixed monthly payment and you get to pick either a BMW or a Chevy to drive. You would be a fool not to pick that BMW.

The fundamental issue with our healthcare is that there is no market. On top of that, we only have BMWs and no Chevys. We need mediocre healthcare, and we need terrible healthcare.
 

Thread Starter

ronv

Joined Nov 12, 2008
3,770
The 3 examples you described are symptoms of the same problem: Americans have largely separated themselves from the purchasing process of health care. The market for health care isn't a market.

The same anomalies would arise if we decided to have someone else pay for our homes, cars or vacations. Some people would have great home, car or vacation "coverage" and not care what they spend on those items. There would be vendors with absurd prices to happily take their payments. Those same vendors would find a way to also sell to folks with lesser or no coverage, enlarging their revenues as much as possible while not selling below cost. If most folks had coverage, prices on average would be much higher. It would be a mess, just like healthcare is.

Nothing can or will fix this without bringing market forces back into play so that, every moment of every day, people shopping for and buying health care cause vendors to offer competitively priced services.
I think you are maybe on the right track, at least with insurance. But I, unlike Joey, think we are the problem not the government. I know, at least in my case, I never thought much about how much my insurance cost, only that it was good. Like you said, I didn't pay for it, my company did. Even when I had my own company it was just a percentage I added to salaries - easy. But strange a company like GM would spend 15K a year for his insurance, then let themselves get screwed. I guess maybe he did benefit from the union even though he wasn't in it. :rolleyes:
My primary care doctor was grumping about it the other day. There are a lot of retirees here so a lot of Medicare. He was complaining he was only making 150K a year. He's not a brain surgeon, but that may not be enough for a guy that's probably still paying off his student loans.
 

joeyd999

Joined Jun 6, 2011
4,410
But I, unlike Joey, think we are the problem not the government.
Speak for yourself. I pay for my own insurance. I saw the doctor this week for the first time in 4 years -- and only 'cause I blew an exhaust valve in my a**. :D

Not fun, BTW.
 

Thread Starter

ronv

Joined Nov 12, 2008
3,770
Speak for yourself. I pay for my own insurance. I saw the doctor this week for the first time in 4 years -- and only 'cause I blew an exhaust valve in my a**. :D

Not fun, BTW.
Sorry to hear about that! upload_2016-1-20_18-8-31.jpeg
So your a good source. What do you pay for your insurance? How did you make out cost wise on the valve job? How about a prescription for special oil?
 

Thread Starter

ronv

Joined Nov 12, 2008
3,770
Considering I paid > $50K (family is covered -- not just me) over the last 4 years, that was the most expensive doctor visit I ever had.
Ouch! That seems to be about the going rate now-days.
Hope everything comes out okay.
 

JoeJester

Joined Apr 26, 2005
4,264
Back in the early 1990s, when the administration had Hillary Clinton heading a government run healthcare study, my WWII veteran Doctor stated he would stop practicing medicine the day the government took over healthcare. He did not like "Hilliary care," as it was called.

Not only are the fees paid by medicare too low, for the services rendered, it seems they want to reduce that cost annually. Some doctors have ordered additional tests, some of which were dubious at best, making it look like that was the way to earn more revenue. Others put forth the idea that in today's litigious society, the extra tests is a CYA move on the doctors.

Fast forward to today, we have government run healthcare. If you don't have it, you will be subject to a tax, called a "shared responsibility payment" that increases year over year for each year you don't have healthcare. This year, the IRS required two new forms with respect to the Affordable Care Act, commonly called Obamacare. The kicker is, they extended the time for the providers to send out those forms. Of course they will take the taxpayers at their word they had healthcare until that form arrives at the IRS. In future years, the IRS expects those forms to be filed as promptly as the W2s.

Those veterans out there, who are in the VA Medical system, had already received their 1095-B, probably in early January. I've seen mine and one other veterans. The other form is 1095-C.

I've had people complain about the cost of "affordable" healthcare. Most stated it wasn't "affordable."
 

dannyf

Joined Sep 13, 2015
2,197
Most stated it wasn't "affordable."
If you think healthcare is too expensive, wait until it is free, :)

We don't have healthcare insurance. We have instead healthcare maintenance. On top of that, we have only high quality expensive healthcare. We don't have low quality affordable care. Because we have taken consumer choices out.
 

Thread Starter

ronv

Joined Nov 12, 2008
3,770
Back in the early 1990s, when the administration had Hillary Clinton heading a government run healthcare study, my WWII veteran Doctor stated he would stop practicing medicine the day the government took over healthcare. He did not like "Hilliary care," as it was called.

Not only are the fees paid by medicare too low, for the services rendered, it seems they want to reduce that cost annually. Some doctors have ordered additional tests, some of which were dubious at best, making it look like that was the way to earn more revenue. Others put forth the idea that in today's litigious society, the extra tests is a CYA move on the doctors.
Yea, I think your right. If it is to low then they start to game the system or the system lets them game it. An example is the one I posted earlier between medicare charges and premium health care. My neighbor across the street had a kid that got cancer. No insurance. My friend had to pay "retail" which was even higher than what the premium insurance would pay. He fought and fought with them to no avail. It turned out alright. Fortunately he was well to do (not so much anymore).:(

I've had people complain about the cost of "affordable" healthcare. Most stated it wasn't "affordable."
I think a decent plan is about the same as Joey's. But if he lived in Arizona it would be $3000 a year less. From the sounds of #12, it doesn't sound like the Drs. are any better.:D Must be the cost of living.
But the problem remains that the costs in the US are substantially higher than other countries that have better results. That's the real question no matter what insurance you have.
 
Top