Gyroscopic Investing

My friend had a minor stroke. Drove himself to hospital and checked in. Had an MRI. Ate three meals. Was observed for 18 hours and was released next morning with a prescription for some blood thinners. Total bill: $42,000

I don't know what it is going to take to fix health care in America but frankly I think that the abuses by the King that led to the Revolutionary War were less egregious than this. 42,000 dollars! Seriously, that is so absurd that it is even hard to intelligibly respond to that short of just faxing the hospital a copy of your middle finger.

All it would take is capitalism.

We won't get it.

All it would take is single-payer.

We won't get it.

What percentage of ER visits go unpaid?  I would guess it's very high.  It's no different than the credit market.  Naturally, if you have a high default rate, you have to raise your costs to pay for those unpaid bills. 

MRI machines cost into the hundreds of thousands of dollars.  Same with med school.  The techs, nurses and overall staff in health care are typically very competent, which doesn't come cheap.

ER visits for primary care was one of the reasons for Obamacare, but from what I've read, ER visits have actually increased and are expected to further. 

moda0306 wrote: All it would take is single-payer.

We won't get it.

Single payer like the VA system?

We have THE single most broken, corrupt, dysfunctional health care system in the world.....

There is absolutely no rational explanation or justification that can be given for a bill of 42,000 dollars..

I bet if one were to look at the itemized receipt it would be something like this:

Hospital Gown: $4000
Breakfast: $600
Cable TV: $1200
Lunch: $800
MRI; $20,000
Nurse Checkup: $2000

and on and on.....

We either need a single payer system, or straight up capitalism and we will just let charities deal with the sick and dying as hospitals turn away people at the front door who cant prove ability to pay for services.

clacy wrote:

moda0306 wrote: All it would take is single-payer.

We won't get it.

Single payer like the VA system?

That's single-payer and single-provider.  Obviously there are problems there.  I think single-provider is probably a bad idea.  Regardless of the politics around it, the VA system is really a tragedy.  And Obama's full of it for having claimed it would be a focus of his.

I'm thinking single-payer like most of the western world has today. Medicare for all.

I was mostly being a bit snarky, though.  I don't think "Medicare for all" would solve much overnight.  However, listening to repubs/conservatives talk about individualizing the health insurance market, using HSA's, and tort reform are going to solve any of the fundamental problems of the "market" is laughable to me. 

My father recently got sick and went to a hospital for some care. It was all covered under his insurance (government insurance; he's a state employee). When he got there, they drew some blood, sent it to a lab and told him he was probably fine. He just got a $600 bill from the lab saying that the insurance didn't pay them. He called the state insurance company who said that they were 52 weeks backlogged and would pay the lab in a year.

It seems like everywhere you look, it's a disaster. This is why I have no faith that single-payer or more government will solve the problem. In the areas they're already doing things, they're royally messing it up. Such systems may work in other countries, but examining the track records of the various branches of American government trying to do such things doesn't exactly fill me with hope.

Honestly, what I see happening is some kind of single-payer/nationalization that itself fails in a variety of ways. I see Americans simply learning to live with bad health care as a cultural oddity.

Pointedstick wrote: My father recently got sick and went to a hospital for some care. It was all covered under his insurance (government insurance; he's a state employee). When he got there, they drew some blood, sent it to a lab and told him he was probably fine. He just got a $600 bill from the lab saying that the insurance didn't pay them. He called the state insurance company who said that they were 52 weeks backlogged and would pay the lab in a year.

It seems like everywhere you look, it's a disaster. This is why I have no faith that single-payer or more government will solve the problem. In the areas they're already doing things, they're royally messing it up. Such systems may work in other countries, but examining the track records of the various branches of American government trying to do such things doesn't exactly fill me with hope.

Honestly, what I see happening is some kind of single-payer/nationalization that itself fails in a variety of ways. I see Americans simply learning to live with bad health care as a cultural oddity.

Our messed up healthcare system is really the only reason I dont retire today. The costs are just too unpredictable....

moda0306 wrote: All it would take is single-payer.

We won't get it.

Given the historical track record of single-payer, I'd have to side with capitalism.  All single-payer does is shift costs inter-generationally; it doesn't actually reduce costs.  Neither does the conservative philosophy known as Obamacare.  But man, I'd sure take single-payer right now over the current nightmare which is cruel joke, especially HMO's.  That's assuming, of course, you actually believe this system does anything ultimately useful besides trauma and emergency.  I don't, but I understand hundreds of millions of people are completely dependent on the medical system instead of self-responsibility/self-empowerment.  I suspect at some point in the future, empowering technology will just completely circumvent the entire debate as irrelevant.  That's how government/institutions become redundant, not ever by an act of will.

doodle wrote: Hospital Gown: $4000
Breakfast: $600
Cable TV: $1200
Lunch: $800
MRI; $20,000
Nurse Checkup: $2000

No one pays full retail bill prices.  If he doesn't have insurance, then he can negotiate it lower by saying the magic words "uninsured cash discount" and/or letting it go to collections and negotiating a final collection amount (though you may owe taxes on the forgiven amount).  It's all a mirage.

I agree with moda that Medicare would be the best single-payer template as you have the freedom to be in fee for service and go to any provider you like or you can join the high volume, cattle car known as HMO via Medicare Advantage.  But if you look closer at the reimbursement situation with Medicare, there's a corrupt and crony opaque committee that sets the rates that providers can charge as well as controlling what can be provided (no alternative health care or life saving experimental procedures/drugs, in other words).  And the best rated providers will not accept Medicare because the reimbursement rate is typically below private insurance.  Its very hard to find a top rated provider who accepts government insurance or more than an extremely limited amount of private insurance, at best.  Medicaid is truly bottom of the barrel for provider quality; hopefully upping the reimbursement rate to Medicare level via Obamacare will improve the provider quality.

doodle wrote: We have THE single most broken, corrupt, dysfunctional health care system in the world.....

There is absolutely no rational explanation or justification that can be given for a bill of 42,000 dollars..

I bet if one were to look at the itemized receipt it would be something like this:

Hospital Gown: $4000
Breakfast: $600
Cable TV: $1200
Lunch: $800
MRI; $20,000
Nurse Checkup: $2000

and on and on.....

We either need a single payer system, or straight up capitalism and we will just let charities deal with the sick and dying as hospitals turn away people at the front door who cant prove ability to pay for services.

Well......Jen Anniston was the nurse and it was a do-do bird egg omlette for breakfast.

doodle wrote:I bet if one were to look at the itemized receipt it would be something like this:

Hospital Gown: $4000
Breakfast: $600
Cable TV: $1200
Lunch: $800
MRI; $20,000
Nurse Checkup: $2000

But if you go to the hospital across the street the bill might be:
Hospital Gown: $200
Breakfast: $6000
Cable TV: $100
Lunch: $10
MRI; $1,642
Nurse Checkup: $9000

or whatever arbitrary numbers they come up with. It might be $42,000 or $82,000 or $4726. What a mess.

$42,000 is just beyond insane, even if your friend got an echocardiogram as well as an MRI.  Of note, an 18 hour admission is not even a hospital admission anymore - Medicare now counts it as "observation".

Some hospitals do inflate the cost to beyond ridiculousness for cash paying patients, knowing full well that they'll get reimbursed for only a tiny percentage.  It's a game mandated by insurance companies, because they will often pay less for reduced charge levels.  Unfortunately, it's actually ILLEGAL to reduce prices for uninsured patients.  Your friend would still have to be charged with the full amount, and then have to ask forgiveness of some of the debt.  Which the hospital may or may not grant.

Also be aware that the $42,000 is only part of your friend's bill because it's likely hospital costs only.  The physicians submit bills separately.

Some kind of national price setting would solve the problem, even in the absence of a single payer system.  Neither of course is likely to happen.

Moda,

Please remember what you wrote here.  Given the trajectory of the country you may very well get something like you have asked for.  I believe there is a chinese curse: be careful what you ask for, for you will surely get it. 

WiseOne wrote: Some kind of national price setting would solve the problem, even in the absence of a single payer system.  Neither of course is likely to happen.

Price controls result in shortages or surpluses. Both make us poorer and hurt our standard of living.

We will get price controls when we get single payer. You won't see the prices though, but the government will. And it will refuse to pay them. That will be the control.

We will see it in the form of people suffering and dying unless they are rich enough to flee the country for a place where there is a market and they can buy the services.

Kshartle wrote:

WiseOne wrote: Some kind of national price setting would solve the problem, even in the absence of a single payer system.  Neither of course is likely to happen.

Price controls result in shortages or surpluses. Both make us poorer and hurt our standard of living.

Natural resources as private property are a price control.  They create artificial scarcity where there once was abundance.

Or so one could reasonably argue .

moda0306 wrote:

Kshartle wrote:

WiseOne wrote: Some kind of national price setting would solve the problem, even in the absence of a single payer system.  Neither of course is likely to happen.

Price controls result in shortages or surpluses. Both make us poorer and hurt our standard of living.

Natural resources as private property are a price control.  They create artificial scarcity where there once was abundance.

Or so one could reasonably argue .

They can be traded for. They can be bid away from the owner if the price offered is high enough. As long as people are willing to pay the price, or more accurately as long as we are able to profit from offereing a service people will think of ways to offer it.

They are available for usage still.

The price system is the signal to potential producers that people prefer something over another (a paticular service over whatever else the money could buy). They then move to supply it. When violent threats are used to prevent the price from moving to a place where producers will create supply you have a shortage. People cannot get as much of a good or service they would prefer to what they have otherwise. This is a lower standard of living.

You could I suppose make up for the lack of incentive by actually enslaving some people and forcing them to produce with threats of violence. This isn't very economical even with basic things like agriculture and I'm sure would fall apart immediately with an industry like healthcare.

We have a sizable Canadian population that winters down here. They wait out the summer months in Canada and come down here and buy dental and medical services. My GF cleans their teeth and hears the complaints. The price controls up there make it impossible to get services done in any reasonable time. Sometimes they have to wait 6 months or more to see a doctor, if ever.

This is the government imposing price controls on the single payer system which it MUST do. It does this by rationing.

There is always rationing. The point is the result of a capitalist market driven system is lower costs and greater supply. Politicians cannot determine resource allocation as effectively as the price system because they cannot reflect the desires and values of the marketplace as well as all the players discovering price on a contiuous basis can.

Just because there is always rationing because at anytime resource are limited doesn't mean we are doomed. The free floating of price will continuously imporve the situation. We can create more healthcare if people are left alone to pursue it for profit.

When it comes to services, more people doesn't mean we need more rationing, it means more potential suppliers.

Imagine if the government said 100 years ago that hair cutting costs were getting too high or we needed to subsidise hair cuts for the poor or whatever. We'd probably have half as many haircuts annualy as we do now, they would be $100 unless the government paid (stole) and you'd probably have a sizable number of haircut fatalitites.

NM, they even restrict haircut supply currently with licensing.

We have a sizable Canadian population that winters down here. They wait out the summer months in Canada and come down here and buy dental and medical services. My GF cleans their teeth and hears the complaints. The price controls up there make it impossible to get services done in any reasonable time. Sometimes they have to wait 6 months or more to see a doctor, if ever.

Then there is always the option to go to a private hospital and pay the additional cost for that.

Anecdotally, I have many European friends that opt to return to Europe to get surgery done there because it is much, much, much cheaper to get a first class plane ticket and 5 star hotel accommodations over there then to get procedure done here. None of them seemed to have to wait inordinately long times to book surgeries either....

Honestly the only way to untie the gordian knot I think is for a bunch of ballsy doctors to set up a hospital where they do what they actually became doctors to do: heal sick people without a bunch of bureaucracy and bullshit. Needless to say, this would be highly illegal, and it would probably precipitate a Waco-type standoff that made people realize the absurdity of the notion of federal laws backed by the government's guns prohibiting healers from healing. The change in our nation's psyche wouldn't happen immediately, but I think it would get the ball rolling, the way Waco had a major impact on the modern gun rights movement, and how since then, we haven't really had any major federal defeats and have begun toll back the leviathan.

doodle wrote:

We have a sizable Canadian population that winters down here. They wait out the summer months in Canada and come down here and buy dental and medical services. My GF cleans their teeth and hears the complaints. The price controls up there make it impossible to get services done in any reasonable time. Sometimes they have to wait 6 months or more to see a doctor, if ever.

Then there is always the option to go to a private hospital and pay the additional cost for that.

Anecdotally, I have many European friends that opt to return to Europe to get surgery done there because it is much, much, much cheaper to get a first class plane ticket and 5 star hotel accommodations over there then to get procedure done here. None of them seemed to have to wait inordinately long times to book surgeries either....

It was my understanding that private medical services for humans was illegal in Canada. You can get your dog in for an MRI that day by might wait months for a human.

Regarding your European friends. I assume this is only because they get the services at no additional cost correct? Americans for instance aren't opting to go to Europe for medical savings correct? They go to Asia and South America where there are markets.

The European governments may be allocating more resources than Canada towards medical services. That isn't evidence that it's better. There is no free lunch. The costs have to paid for elsewhere through taxes, inflation or government debt, all damaging to the economy. Note the unemployment rates throughout Europe despite the wonderful healthcare.

You have a lot of European friends getting surgeries?

I still think the best solution would be a nationalized single payer system with market incentives.

Such a setup could be:

Every American gets $500 dollars every year in a health savings account to spend for preventative care. If you don't spend it, the amount rolls over to the next year.

The next $1000 dollars of spending comes straight out of pocket and can be garnered from wages or tax refunds if people try to walk away from bills. This would dissuade people from going to doctors for minor illnesses like sore throats or what not.

After that the next $5000 would be covered by insurance on an 80/20 split.

After this max is reached people would be covered completely by system.

There would also be an educational movement to make people aware that costly end of life procedures take away resources from young children or mothers and fathers who are raising families. Hopefully a slow cultural shift would take place in terms of keeping terminal patients alive through costly procedures. The other option could be to provide such services only for those who were able to pay for it.

Kshartle wrote:

doodle wrote:

We have a sizable Canadian population that winters down here. They wait out the summer months in Canada and come down here and buy dental and medical services. My GF cleans their teeth and hears the complaints. The price controls up there make it impossible to get services done in any reasonable time. Sometimes they have to wait 6 months or more to see a doctor, if ever.

Then there is always the option to go to a private hospital and pay the additional cost for that.

Anecdotally, I have many European friends that opt to return to Europe to get surgery done there because it is much, much, much cheaper to get a first class plane ticket and 5 star hotel accommodations over there then to get procedure done here. None of them seemed to have to wait inordinately long times to book surgeries either....

It was my understanding that private medical services for humans was illegal in Canada. You can get your dog in for an MRI that day by might wait months for a human.

Regarding your European friends. I assume this is only because they get the services at no additional cost correct? Americans for instance aren't opting to go to Europe for medical savings correct? They go to Asia and South America where there are markets.

The European governments may be allocating more resources than Canada towards medical services. That isn't evidence that it's better. There is no free lunch. The costs have to paid for elsewhere through taxes, inflation or government debt, all damaging to the economy. Note the unemployment rates throughout Europe despite the wonderful healthcare.

You have a lot of European friends getting surgeries?

Wait times in the United States aren't great either.

In 2007, the Commonwealth Fund released a report that compared U.S. health care against several other countries based on a variety of benchmarks. The data were principally derived from statistically random surveys of adult residents and primary care physicians from 2004 to 2006, in the following countries: United States, Canada, New Zealand, United Kingdom, Germany, and the Netherlands. This is what the researchers found:

* Canada had the highest percentage of patients (36%) who had to wait six days or more for an appointment with a doctor, but the United States had the second highest percentage (23%) who reported that they had to wait at least this long. New Zealand, Australia, Germany, and the U.K. all had substantially smaller numbers of people reporting waits of 6 days or longer. Canada and the United States, in that order, also had the lowest percentage of persons who said they could get an appointment with a doctor the same or next day.

* The United States had the largest percentage of persons (61%) who said that getting care on nights, weekends, or holidays, without going to the emergency room, was “very”? or “somewhat”? difficult. In Canada, it was 54%, and in the U.K, 38%. Germany did the best, with only 22% saying that it was difficult to get after-hours care.

Pointedstick wrote: Honestly the only way to untie the gordian knot I think is for a bunch of ballsy doctors to set up a hospital where they do what they actually became doctors to do: heal sick people without a bunch of bureaucracy and bullshit. Needless to say, this would be highly illegal, and it would probably precipitate a Waco-type standoff that made people realize the absurdity of the notion of federal laws backed by the government's guns prohibiting healers from healing. The change in our nation's psyche wouldn't happen immediately, but I think it would get the ball rolling, the way Waco had a major impact on the modern gun rights movement, and how since then, we haven't really had any major federal defeats and have begun toll back the leviathan.

They should do it near Clive Bundy's ranch.

It would be hard for the jackboots to kidnapp or shoot unarmed doctors and nurses for selling medical services, especially if they are paying taxes.

doodle wrote: Wait times in the United States aren't great either.

Healthcare here is in shambles, agreed.