6 ms·

Procedures can't cost more than the average cost of the same procedure across similar oecd countries. We pop the corruption bubble and all fights about insuran

by pfisch 8y ago

Procedures can't cost more than the average cost of the same procedure across similar oecd countries. We pop the corruption bubble and all fights about insurance costs would just disappear because in reality the reason they are so high is because all of this is just a shakedown from the medical/pharma industry. I'm so sick of this all being framed as a battle over single/multi provider obamacare insurance bullshit when it is really just misdirection and we are being wildly overcharged for services. It's like we can only debate whether we pay 1000% markup using a credit card, paypal or cash, and not talk about the 1000% markup.

aidenn0 8y ago
But where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash.
- itronitron 8y ago
  The money is probably going into custom homes, the practice, malpractice insurance, children's education, restaurants, and vacations.
  - darawk 8y ago
    What? No. Doctors make good money, but not enough to explain anywhere near the costs seen in the healthcare system. Doctors make between 200k and 1mm/year depending on how specialized they are. That isn't even close to sufficient to explain the cost inflation in healthcare.
    - itronitron 8y ago
      True, I am just pointing out where their income is likely going. Is there any good source of hard data on the billing amounts and quantity by doctor, practice, or hospital?
    - pishpash 8y ago
      It's the administrative apparatus of hospitals. Not only doctors, but staff, admins, real estate, etc. Notice how swanky some "clinics" are? Also doctors' pay does grow at super-inflationary rates according to data. That's at least part of the story.
    - nicoburns 8y ago
      I agree that doctors aren't where the money is going, but that's still a lot more than doctors in the UK earn! https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-doctors%20 https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-d...
  - maxxxxx 8y ago
    Maseratis are also not cheap.
    - lotsofpulp 8y ago
      Maseratis are the lower tier of luxury cars.
  - pishpash 8y ago
    Isn't a big portion going into paying back med school loans? If so then you're also subsidizing the private education sector, another example of market failure.
- mcny 8y ago
  > But where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash. The average debt is reportedly $190k for medical school graduates. > The country should follow N.Y.U.’s lead in recognizing the damage wrought by crushing student debt. Making higher education free for all should not just be a pipe dream. I don't know how I feel about this. I for one expect people who make over five times our target minimum wage[1] to contribute more through income taxes than they do now. While I agree people at higher levels should progressively pay dramatically more in taxes, if I were to run for political office today, I'd run on the platform of increased (federal) individual income tax for all and an eventual end to all tax credits, deductions, and any such incentives. How will these high earners pay my demands for a higher income tax if they have trouble paying their loans? I understand that take home pay per month with $180k salary is about $9k per month[2]. Let us say your student loan payment is about $2k[3]. Let us say that your medical insurance and other career related expenses are about $1k. This still leaves you with about $6k per month. Assuming you save half your income (which I hope you do at this income level), you have about $3k a month to spend on rent, groceries, and transit. Assuming you don't have any children and don't have any plans to have any children, this is not a bad spot to be in. Sure, one is not wealthy or financially independent until you are like 65 if you started working at 30, but if one wanted to make money, why is one in the medical field? In my opinion, it is kind of absurd to get into medicine and expect to become wealthy. [1] Target minimum wage of $15 an hour at two thousand hours a year is $30,000. Five times $30,000 is $150,000. [2] https://screenshotscdn.firefoxusercontent.com/images/f645f479-93ec-4185-97bf-8a96c7db3271.png https://screenshotscdn.firefoxusercontent.com/images/f645f47... https://screenshotscdn.firefoxusercontent.com/images/ecf93872-e97d-463d-a327-0cc557296d0c.png https://screenshotscdn.firefoxusercontent.com/images/ecf9387... I initially made the calculation with semi-monthly pay checks which made me doubt my math a little. I have since corrected it to a monthly pay check. [3] https://screenshotscdn.firefoxusercontent.com/images/61e426ec-8e53-4859-a178-db2960fb3991.png https://screenshotscdn.firefoxusercontent.com/images/61e426e... Interest rates vary but I am pushing for an aggressive twenty year loan which you should be able to refinance when times are good. https://members.aamc.org/eweb/upload/Education%20Debt%20Manager%20for%20Graduating%20Medical%20School%20Students--2017.pdf https://members.aamc.org/eweb/upload/Education%20Debt%20Mana... https://www.nytimes.com/2018/08/20/opinion/medical-school-student-loans-tuition-debt-doctor.html https://www.nytimes.com/2018/08/20/opinion/medical-school-st... Outline: https://outline.com/Cy2Pdp https://outline.com/Cy2Pdp Archive: https://archive.fo/dxmZG https://archive.fo/dxmZG
analog31 8y ago
In my view, the only way to reduce the cost is to figure out where the money is going. Otherwise, everybody can say: "We had to charge $58000 because we had to pay someone else $57000." Right now everybody points to everybody else as the culprit for high health care costs. A centralized system has a better way of tracking this. If everybody involved with the health care system is working for a government salary, and everybody who sells equipment is selling it to the government, then we know who is getting rich by exactly how much.
- AnthonyMouse 8y ago
  > In my view, the only way to reduce the cost is to figure out where the money is going. It isn't going to any specific place. The system is designed to destroy price sensitivity, so everything is overpriced and everyone is charged for things they don't actually need. When there is a bill for $58000, it's not that the procedure costs $1000 and there is this one place receiving the remaining balance we could just cut out. It's that the procedure would cost $1000 only everything that should have cost $20 was charged for $200 and then 500% more steps were performed than were necessary. Trying to play the blame game is pointless because everyone will come up with a reason to justify their high margin or unnecessary step and the truth is nobody is innocent. What's needed is to actually make purchasing decisions based on price. If one provider charges $58000 and the other charges $56000, the patient should know ahead of time that there is a $2000 price difference, and actually pay the entire $2000 less by choosing the less expensive one. Do that and there is price competition, and the provider that does the work of eliminating unnecessary costs for you will be the one with the lowest price. And once you have someone offering to do a $1000 procedure for $1000, who is going to pay $58000?
  - pfisch 8y ago
    Why should we have to figure this shit out for them at all!? This procedure costs $x because it is the oecd average cost and that is the end of the discussion. It is on them to fight over their slices of the pie with each other. They don't get to make their problems our problems. Its not realistic to act like people have time to price compare for emergency medical services. It just isn't a normal free market so much as it is like a mugging. When you get mugged the question is how much will you trade for your life, and the answer is everything you have. We need to stop pretending like it is a free market and trying to apply free market solutions that do not apply.
wstrange 8y ago
Single payer cuts out an entire tier of administrative costs from health care delivery. This is not insignficant. It also provide more control over wages, drug costs etc. For example, Canadian doctors make less than their US counterparts. https://nationalpost.com/news/canada/canadian-doctors-still-make-dramatically-less-than-u-s-counterparts-study https://nationalpost.com/news/canada/canadian-doctors-still-...
- pfisch 8y ago
  Here is the main problem with this line of reasoning. Canada is not captured by a huge pharma/medical industry like the US is. If we do this we will have even less recourse and there will be even less accountability when regulatory capture happens and prices are driven up even higher because all the lobbying money can be focused like a laser now on this one board that we are going to create to manage everything. The current system is totally fucked, but once the price concerns are made a tragedy of the commons through taxes the medical industry will be able to drive prices even higher just like how the government isn't allowed to negotiate drug prices for medicare right now. How can you not see the insane level of corruption already baked into the system when we have a policy currently where the government can't negotiate drug prices? How fucked up must the system be for that to have ever even gotten to the stage of being considered as a serious proposal, much less implemented? Without attacking the corruption in the system I just don't think sweeping it under the rug and throwing it on the deficit is a reasonable plan.
  - wstrange 8y ago
    > Canada is not captured by a huge pharma/medical industry like the US is I think you are making the case for single payer. The government has much more power to reign in the pharma/medical industry. See the linked article on Doctor salaries.
    - pfisch 8y ago
      Government's have power to reign in industries until those industries get too large and entrench themselves within the government. Look at the biggest industries in any free country and you can see it replay over and over again around the world. Our problem unlike the rest of the world is that pharma and medical is our industry. That is the main reason our prices are crazy compared to everyone else.
fzeroracer 8y ago
Personally, I would gladly take a tax hike to avoid ever having to think about medical bullshit ever again. I don't want to haggle any damn prices for shit that I need and I don't want to have to deal with the corrupt and overpaid insurance industry squeezing me dry. The fact that my family's first response to requesting any sort of aid for their problems is an immediate denial followed by weeks of dealing with paperwork bullshit indicates the system is fucked beyond belief. We're being wildly overcharged for basic services because ultimately that's exactly how the market is designed to work.
- pfisch 8y ago
  So you think if we take all these smaller insurance companies and combine them into one large entity that will fix our overpricing problems? It seems like we will have even less recourse and there will be even less accountability when regulatory capture happens and prices are driven up even higher because all the lobbying money can be focused like a laser now. I also think the current system is totally fucked, but once the price concerns are made a tragedy of the commons through taxes the medical industry will drive prices even higher. Without attacking the corruption in the system I just don't think sweeping it under the rug and throwing it on the deficit is a good long term plan.
  - patmcc 8y ago
    Literally every other developed nation has figured this out. Here's one way to solve this: single payer. The payer (government) sets the price and the doctors either accept it or stop treating patients. Maybe they'll bill 15% less a year, but they'll also never have to deal with this debt collecting bullshit, so they don't need as many staff.
    - pfisch 8y ago
      Literally every other nation isn't captured by the medical/pharmaceutical industry. Our pharma industry is equivalent in size to the sum of every other pharma industry in the top 10 put together. Do any of those other countries have a policy that their government is not allowed to negotiate drug prices? Our medicare system has that rule. We have a system so incredibly captured by the pharma industry that it could actually approve a proposal that the government shouldn't negotiate drug prices with our own tax dollars. Even though everyone knows Medicare is going bankrupt, somehow we can just keep overpaying for drugs. The problem is that the biggest industries in any free country always take over politics and dictate the policies around their industry. That is why single payer will not be a panacea for us, it will be a feeding frenzy of government money being transferred to private industry. Until we make moves to clear out the corruption, granting the government more power to transfer our taxes to the pharma companies is just going to be a blood bath.

by pfisch 8y ago

aidenn0 8y ago

But where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash.

itronitron 8y ago
The money is probably going into custom homes, the practice, malpractice insurance, children's education, restaurants, and vacations.
- darawk 8y ago
  What? No. Doctors make good money, but not enough to explain anywhere near the costs seen in the healthcare system. Doctors make between 200k and 1mm/year depending on how specialized they are. That isn't even close to sufficient to explain the cost inflation in healthcare.
  - itronitron 8y ago
    True, I am just pointing out where their income is likely going. Is there any good source of hard data on the billing amounts and quantity by doctor, practice, or hospital?
  - pishpash 8y ago
    It's the administrative apparatus of hospitals. Not only doctors, but staff, admins, real estate, etc. Notice how swanky some "clinics" are? Also doctors' pay does grow at super-inflationary rates according to data. That's at least part of the story.
  - nicoburns 8y ago
    I agree that doctors aren't where the money is going, but that's still a lot more than doctors in the UK earn! https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-doctors%20 https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-d...
- maxxxxx 8y ago
  Maseratis are also not cheap.
  - lotsofpulp 8y ago
    Maseratis are the lower tier of luxury cars.
- pishpash 8y ago
  Isn't a big portion going into paying back med school loans? If so then you're also subsidizing the private education sector, another example of market failure.
mcny 8y ago
> But where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash. The average debt is reportedly $190k for medical school graduates. > The country should follow N.Y.U.’s lead in recognizing the damage wrought by crushing student debt. Making higher education free for all should not just be a pipe dream. I don't know how I feel about this. I for one expect people who make over five times our target minimum wage[1] to contribute more through income taxes than they do now. While I agree people at higher levels should progressively pay dramatically more in taxes, if I were to run for political office today, I'd run on the platform of increased (federal) individual income tax for all and an eventual end to all tax credits, deductions, and any such incentives. How will these high earners pay my demands for a higher income tax if they have trouble paying their loans? I understand that take home pay per month with $180k salary is about $9k per month[2]. Let us say your student loan payment is about $2k[3]. Let us say that your medical insurance and other career related expenses are about $1k. This still leaves you with about $6k per month. Assuming you save half your income (which I hope you do at this income level), you have about $3k a month to spend on rent, groceries, and transit. Assuming you don't have any children and don't have any plans to have any children, this is not a bad spot to be in. Sure, one is not wealthy or financially independent until you are like 65 if you started working at 30, but if one wanted to make money, why is one in the medical field? In my opinion, it is kind of absurd to get into medicine and expect to become wealthy. [1] Target minimum wage of $15 an hour at two thousand hours a year is $30,000. Five times $30,000 is $150,000. [2] https://screenshotscdn.firefoxusercontent.com/images/f645f479-93ec-4185-97bf-8a96c7db3271.png https://screenshotscdn.firefoxusercontent.com/images/f645f47... https://screenshotscdn.firefoxusercontent.com/images/ecf93872-e97d-463d-a327-0cc557296d0c.png https://screenshotscdn.firefoxusercontent.com/images/ecf9387... I initially made the calculation with semi-monthly pay checks which made me doubt my math a little. I have since corrected it to a monthly pay check. [3] https://screenshotscdn.firefoxusercontent.com/images/61e426ec-8e53-4859-a178-db2960fb3991.png https://screenshotscdn.firefoxusercontent.com/images/61e426e... Interest rates vary but I am pushing for an aggressive twenty year loan which you should be able to refinance when times are good. https://members.aamc.org/eweb/upload/Education%20Debt%20Manager%20for%20Graduating%20Medical%20School%20Students--2017.pdf https://members.aamc.org/eweb/upload/Education%20Debt%20Mana... https://www.nytimes.com/2018/08/20/opinion/medical-school-student-loans-tuition-debt-doctor.html https://www.nytimes.com/2018/08/20/opinion/medical-school-st... Outline: https://outline.com/Cy2Pdp https://outline.com/Cy2Pdp Archive: https://archive.fo/dxmZG https://archive.fo/dxmZG

analog31 8y ago

In my view, the only way to reduce the cost is to figure out where the money is going. Otherwise, everybody can say: "We had to charge $58000 because we had to pay someone else $57000." Right now everybody points to everybody else as the culprit for high health care costs. A centralized system has a better way of tracking this. If everybody involved with the health care system is working for a government salary, and everybody who sells equipment is selling it to the government, then we know who is getting rich by exactly how much.

AnthonyMouse 8y ago
> In my view, the only way to reduce the cost is to figure out where the money is going. It isn't going to any specific place. The system is designed to destroy price sensitivity, so everything is overpriced and everyone is charged for things they don't actually need. When there is a bill for $58000, it's not that the procedure costs $1000 and there is this one place receiving the remaining balance we could just cut out. It's that the procedure would cost $1000 only everything that should have cost $20 was charged for $200 and then 500% more steps were performed than were necessary. Trying to play the blame game is pointless because everyone will come up with a reason to justify their high margin or unnecessary step and the truth is nobody is innocent. What's needed is to actually make purchasing decisions based on price. If one provider charges $58000 and the other charges $56000, the patient should know ahead of time that there is a $2000 price difference, and actually pay the entire $2000 less by choosing the less expensive one. Do that and there is price competition, and the provider that does the work of eliminating unnecessary costs for you will be the one with the lowest price. And once you have someone offering to do a $1000 procedure for $1000, who is going to pay $58000?
- pfisch 8y ago
  Why should we have to figure this shit out for them at all!? This procedure costs $x because it is the oecd average cost and that is the end of the discussion. It is on them to fight over their slices of the pie with each other. They don't get to make their problems our problems. Its not realistic to act like people have time to price compare for emergency medical services. It just isn't a normal free market so much as it is like a mugging. When you get mugged the question is how much will you trade for your life, and the answer is everything you have. We need to stop pretending like it is a free market and trying to apply free market solutions that do not apply.

wstrange 8y ago

Single payer cuts out an entire tier of administrative costs from health care delivery. This is not insignficant. It also provide more control over wages, drug costs etc. For example, Canadian doctors make less than their US counterparts. https://nationalpost.com/news/canada/canadian-doctors-still-make-dramatically-less-than-u-s-counterparts-study https://nationalpost.com/news/canada/canadian-doctors-still-...

pfisch 8y ago
Here is the main problem with this line of reasoning. Canada is not captured by a huge pharma/medical industry like the US is. If we do this we will have even less recourse and there will be even less accountability when regulatory capture happens and prices are driven up even higher because all the lobbying money can be focused like a laser now on this one board that we are going to create to manage everything. The current system is totally fucked, but once the price concerns are made a tragedy of the commons through taxes the medical industry will be able to drive prices even higher just like how the government isn't allowed to negotiate drug prices for medicare right now. How can you not see the insane level of corruption already baked into the system when we have a policy currently where the government can't negotiate drug prices? How fucked up must the system be for that to have ever even gotten to the stage of being considered as a serious proposal, much less implemented? Without attacking the corruption in the system I just don't think sweeping it under the rug and throwing it on the deficit is a reasonable plan.
- wstrange 8y ago
  > Canada is not captured by a huge pharma/medical industry like the US is I think you are making the case for single payer. The government has much more power to reign in the pharma/medical industry. See the linked article on Doctor salaries.
  - pfisch 8y ago
    Government's have power to reign in industries until those industries get too large and entrench themselves within the government. Look at the biggest industries in any free country and you can see it replay over and over again around the world. Our problem unlike the rest of the world is that pharma and medical is our industry. That is the main reason our prices are crazy compared to everyone else.

fzeroracer 8y ago

Personally, I would gladly take a tax hike to avoid ever having to think about medical bullshit ever again. I don't want to haggle any damn prices for shit that I need and I don't want to have to deal with the corrupt and overpaid insurance industry squeezing me dry. The fact that my family's first response to requesting any sort of aid for their problems is an immediate denial followed by weeks of dealing with paperwork bullshit indicates the system is fucked beyond belief. We're being wildly overcharged for basic services because ultimately that's exactly how the market is designed to work.

pfisch 8y ago
So you think if we take all these smaller insurance companies and combine them into one large entity that will fix our overpricing problems? It seems like we will have even less recourse and there will be even less accountability when regulatory capture happens and prices are driven up even higher because all the lobbying money can be focused like a laser now. I also think the current system is totally fucked, but once the price concerns are made a tragedy of the commons through taxes the medical industry will drive prices even higher. Without attacking the corruption in the system I just don't think sweeping it under the rug and throwing it on the deficit is a good long term plan.
- patmcc 8y ago
  Literally every other developed nation has figured this out. Here's one way to solve this: single payer. The payer (government) sets the price and the doctors either accept it or stop treating patients. Maybe they'll bill 15% less a year, but they'll also never have to deal with this debt collecting bullshit, so they don't need as many staff.
  - pfisch 8y ago
    Literally every other nation isn't captured by the medical/pharmaceutical industry. Our pharma industry is equivalent in size to the sum of every other pharma industry in the top 10 put together. Do any of those other countries have a policy that their government is not allowed to negotiate drug prices? Our medicare system has that rule. We have a system so incredibly captured by the pharma industry that it could actually approve a proposal that the government shouldn't negotiate drug prices with our own tax dollars. Even though everyone knows Medicare is going bankrupt, somehow we can just keep overpaying for drugs. The problem is that the biggest industries in any free country always take over politics and dictate the policies around their industry. That is why single payer will not be a panacea for us, it will be a feeding frenzy of government money being transferred to private industry. Until we make moves to clear out the corruption, granting the government more power to transfer our taxes to the pharma companies is just going to be a blood bath.