6 ms·

I paid 400 dollars to have a doctor tell me to neti pot my nose after having sinus infection for 3 months. Might not be rational but fuck everything about this

I paid 400 dollars to have a doctor tell me to neti pot my nose after having sinus infection for 3 months. Might not be rational but fuck everything about this system. Who is pocketing all this goddamn money?

lurkertroll 8y ago
The Dr and the insurance company... who else would it be?
colechristensen 8y ago
Malpractice lawyers and insurance, administrative juggling of data and insurance claims, medical equipment manufactures and certification, doctors (by proxy medical schools and loan providers), practices recovering unpaid bills, and real estate owners.
- sexyflanders 8y ago
  Not to mention pharmaceutical companies charging astronomical prices for prescription meds.
brudgers 8y ago
Through no fault of the author, this comment thread explains the trick. The article talks about US health care access but the discussion quickly goes off into the weeds of the US health insurance market. As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics. All that money is pocketed by businesses run for profit. It's pocketed because it can be. It can be because untreated a sinus infection can kill you. Not a bad business to be in by the standards of business.
- samirillian 8y ago
  You make it sound like the business isn't run by humans. Do you consider price gouging sick people and ethical business to get into? If not, please make that a bit more clear in your comment.
  - joering2 8y ago
    Being run by humans doesn't mean there is empathy built-in; to the contrary because its run by masses of humans, its out of touch with reality and majority of involved will tell you someone else makes final decision, while the rest will simply follow others. Its as numb as long hand of government can be. They don't see human patients with names and families, they same charts and graphs with numbers and profit/loss cells combined. Its not ethical business but ethics doesn't matter much these days (devil's advocate here); heck one can argue even legality doesn't matter, as for example Wells Fargo has been getting away with daylight theft that would put a single person in prison for one million years.
    - samirillian 8y ago
      So we have a problem: 1. assume businesses cannot be ethical. 2. so, telling a business to be ethical is pointless 3. to encourage prosocial behavior amongst businesses, they must, therefore, be regulated 4. but, since businesses cannot be ethical, they can use their power to control regulation how to stop this hellscape? is it possible that assuming businesses cannot possibly act ethically was a lie spread by said companies? tldr; then what's the solution, assuming regulatory capture is a thing?
  - deleted 8y ago
    [deleted]
- AnthonyMouse 8y ago
  > As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics. To provide healthcare you need doctors, who need money to pay rent and student loans. You need an office to put the doctors in. You need drugs and medical devices, and researchers to come up with them. You need lawyers to keep the doctors from conducting the Tuskegee Experiment. And nurses and lab techs and janitors etc. That is all business stuff. Paying employees and managing offices etc. If you don't pay the employees enough then they get another job and quality of care suffers. If you pay them too much then costs get out of hand. The way you determine how much is the right amount is by letting people choose how much to pay for it. If you have a runny nose and the doctor wants ten million dollars to see you for five minutes, you blow them off as unreasonable and get a different doctor. If you demand to see them for $10 and that isn't enough to cover their costs, they blow you off as unreasonable and get a different patient. Somewhere in the middle there is a price above what it costs and below what it's worth where you neither die of a sinus infection nor sell your first born to have it cured. There are a lot of reasons this works poorly in the US. Low deductible employer-provided health plans making consumers price insensitive, lack of price transparency, an excessively burdensome FDA approval process that impairs competition between pharma companies, etc. But those are specific failings that could be addressed. Switching to central planning just adds a new problem without solving the existing ones. If consumers pay nothing, not even actual cost, there is even less incentive to forego unnecessary procedures. Setting prices by committee is a sure way to either overpay (and waste money) or underpay (and get supply shortages). If drug companies still set prices then costs remain high, but if they can't charge the prices they do and still have to go through the same very expensive approval process, you stop getting new drugs. And then you add another trillion tax dollars to the budget which every campaign donor in the country will have a chance to divert a chunk of away from actual medicine and into their own pockets. > All that money is pocketed by businesses run for profit. The significant majority of that money typically goes to employees, not shareholders. The costs are too high, but it's not because the average medical practice is turning a huge profit, it's because the existing regulatory environment causes providing medicine to be unnecessarily labor intensive (i.e. inefficient).
  - brudgers 8y ago
    And yet, here we are talking about business instead of health.
- tomjen3 8y ago
  But so is food, and while I probably won't die in the next 6 months from lack of medical attention, if the groceries shut down I would. Yet the US medical system is a giant clusterfuck of burned money, and the US food system can provide food at some of the lowest prices in the developed world. US chicken is half what I have to pay in Europe.
  - apexalpha 8y ago
    That is a choice regarding animal welfare and food standards, though. Not because the EU doesn't know how to produce chickens efficiently.
- heisenbit 8y ago
  Exactly. German perspective here: I pay for my public health care quite a lot. Probably around $10.000 a year pre-tax which is half coming from my employer and half out of my pocket. My wife is having a private insurance and is paying a little less. That is ok, even if I don't think her option should exist and the overall system is only working due to the gating for the private option. I'm earning above average and am paying for some who earn less. Any public option that covers a large population section needs to include some redistribution aspects. Because health care is too expensive for people on lower incomes. But it does not need to be as expensive as in the US i.e. twice as expensive as anywhere else and no better outcomes. Insurance companies are not the party that is benefiting the most. They make money and probably more than they should but this does not explain the difference. Most doctors are also not swimming in money. So where does it go? One is Pharma companies who are then using that money to do marketing. So Pharma Marketing gets a share including doctors taking money from that source (another whole can of worms). Larger hospital organizations and their management as one of the stronger buyers of services being able to push for high rates and low salaries. Bill adjusters, debt collectors, partly working in insurance companies (where they contribute to insurance cost) to deal with the chaotic billing, payments and non-payments. There are many, many who earn a good living who would not be able to get similar jobs in other advanced countries as these jobs simply do not exist. The US system is inefficient but there are powerful incentives for many to keep it going. It is really important to separate access from payment. Otherwise small wounds will fester until it is too late or really expensive. A good compromise imho. is having some small access fee (in Germany we had a once per quarter 10 Euro fee on top of a 5€ per prescription fee. That was too much for low income and too much paperwork and the former was scrapped) as we know there is a huge difference between demand for free services and services that cost $0.01.
mattigames 8y ago
Does it matter who? They charge you because they can, America decided your survival (AKA health) is just another business an you can be charged as much as you are willing to pay for it; and those companies -with the help of cultural baggage- have convinced a significant chunk of the population that this shady business is part of the "freedoms" you have as American, because controlling the prices would be "communism" or "socialism", words we all were taught to associate with evilness and enemies.
gjs278 8y ago
maybe you should have come to that conclusion on your own before wasting the doctors time
bequanna 8y ago
The armies of administrative workers: 1. https://www.advisory.com/daily-briefing/2018/07/23/administrative-costs https://www.advisory.com/daily-briefing/2018/07/23/administr... 2. https://www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/insight/expert-forum-rise-and-r...
war1025 8y ago
I just paid $1436 because we took our 1 year old son in when he had a stomach bug and they decided they needed to keep him for 24 hours for observation after giving him an IV to re-hydrate him. Glad he's okay, but if I knew we would be out $1500, I don't know that we would have taken him in.
- asdf333 8y ago
  this exactly. we need to change the system so prices are up front and something you can look up on the internet just like restaurant menus

lurkertroll 8y ago

The Dr and the insurance company... who else would it be?

colechristensen 8y ago

Malpractice lawyers and insurance, administrative juggling of data and insurance claims, medical equipment manufactures and certification, doctors (by proxy medical schools and loan providers), practices recovering unpaid bills, and real estate owners.

sexyflanders 8y ago
Not to mention pharmaceutical companies charging astronomical prices for prescription meds.

brudgers 8y ago

Through no fault of the author, this comment thread explains the trick. The article talks about US health care access but the discussion quickly goes off into the weeds of the US health insurance market. As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics. All that money is pocketed by businesses run for profit. It's pocketed because it can be. It can be because untreated a sinus infection can kill you. Not a bad business to be in by the standards of business.

samirillian 8y ago
You make it sound like the business isn't run by humans. Do you consider price gouging sick people and ethical business to get into? If not, please make that a bit more clear in your comment.
- joering2 8y ago
  Being run by humans doesn't mean there is empathy built-in; to the contrary because its run by masses of humans, its out of touch with reality and majority of involved will tell you someone else makes final decision, while the rest will simply follow others. Its as numb as long hand of government can be. They don't see human patients with names and families, they same charts and graphs with numbers and profit/loss cells combined. Its not ethical business but ethics doesn't matter much these days (devil's advocate here); heck one can argue even legality doesn't matter, as for example Wells Fargo has been getting away with daylight theft that would put a single person in prison for one million years.
  - samirillian 8y ago
    So we have a problem: 1. assume businesses cannot be ethical. 2. so, telling a business to be ethical is pointless 3. to encourage prosocial behavior amongst businesses, they must, therefore, be regulated 4. but, since businesses cannot be ethical, they can use their power to control regulation how to stop this hellscape? is it possible that assuming businesses cannot possibly act ethically was a lie spread by said companies? tldr; then what's the solution, assuming regulatory capture is a thing?
- deleted 8y ago
  [deleted]
AnthonyMouse 8y ago
> As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics. To provide healthcare you need doctors, who need money to pay rent and student loans. You need an office to put the doctors in. You need drugs and medical devices, and researchers to come up with them. You need lawyers to keep the doctors from conducting the Tuskegee Experiment. And nurses and lab techs and janitors etc. That is all business stuff. Paying employees and managing offices etc. If you don't pay the employees enough then they get another job and quality of care suffers. If you pay them too much then costs get out of hand. The way you determine how much is the right amount is by letting people choose how much to pay for it. If you have a runny nose and the doctor wants ten million dollars to see you for five minutes, you blow them off as unreasonable and get a different doctor. If you demand to see them for $10 and that isn't enough to cover their costs, they blow you off as unreasonable and get a different patient. Somewhere in the middle there is a price above what it costs and below what it's worth where you neither die of a sinus infection nor sell your first born to have it cured. There are a lot of reasons this works poorly in the US. Low deductible employer-provided health plans making consumers price insensitive, lack of price transparency, an excessively burdensome FDA approval process that impairs competition between pharma companies, etc. But those are specific failings that could be addressed. Switching to central planning just adds a new problem without solving the existing ones. If consumers pay nothing, not even actual cost, there is even less incentive to forego unnecessary procedures. Setting prices by committee is a sure way to either overpay (and waste money) or underpay (and get supply shortages). If drug companies still set prices then costs remain high, but if they can't charge the prices they do and still have to go through the same very expensive approval process, you stop getting new drugs. And then you add another trillion tax dollars to the budget which every campaign donor in the country will have a chance to divert a chunk of away from actual medicine and into their own pockets. > All that money is pocketed by businesses run for profit. The significant majority of that money typically goes to employees, not shareholders. The costs are too high, but it's not because the average medical practice is turning a huge profit, it's because the existing regulatory environment causes providing medicine to be unnecessarily labor intensive (i.e. inefficient).
- brudgers 8y ago
  And yet, here we are talking about business instead of health.
tomjen3 8y ago
But so is food, and while I probably won't die in the next 6 months from lack of medical attention, if the groceries shut down I would. Yet the US medical system is a giant clusterfuck of burned money, and the US food system can provide food at some of the lowest prices in the developed world. US chicken is half what I have to pay in Europe.
- apexalpha 8y ago
  That is a choice regarding animal welfare and food standards, though. Not because the EU doesn't know how to produce chickens efficiently.
heisenbit 8y ago
Exactly. German perspective here: I pay for my public health care quite a lot. Probably around $10.000 a year pre-tax which is half coming from my employer and half out of my pocket. My wife is having a private insurance and is paying a little less. That is ok, even if I don't think her option should exist and the overall system is only working due to the gating for the private option. I'm earning above average and am paying for some who earn less. Any public option that covers a large population section needs to include some redistribution aspects. Because health care is too expensive for people on lower incomes. But it does not need to be as expensive as in the US i.e. twice as expensive as anywhere else and no better outcomes. Insurance companies are not the party that is benefiting the most. They make money and probably more than they should but this does not explain the difference. Most doctors are also not swimming in money. So where does it go? One is Pharma companies who are then using that money to do marketing. So Pharma Marketing gets a share including doctors taking money from that source (another whole can of worms). Larger hospital organizations and their management as one of the stronger buyers of services being able to push for high rates and low salaries. Bill adjusters, debt collectors, partly working in insurance companies (where they contribute to insurance cost) to deal with the chaotic billing, payments and non-payments. There are many, many who earn a good living who would not be able to get similar jobs in other advanced countries as these jobs simply do not exist. The US system is inefficient but there are powerful incentives for many to keep it going. It is really important to separate access from payment. Otherwise small wounds will fester until it is too late or really expensive. A good compromise imho. is having some small access fee (in Germany we had a once per quarter 10 Euro fee on top of a 5€ per prescription fee. That was too much for low income and too much paperwork and the former was scrapped) as we know there is a huge difference between demand for free services and services that cost $0.01.

mattigames 8y ago

Does it matter who? They charge you because they can, America decided your survival (AKA health) is just another business an you can be charged as much as you are willing to pay for it; and those companies -with the help of cultural baggage- have convinced a significant chunk of the population that this shady business is part of the "freedoms" you have as American, because controlling the prices would be "communism" or "socialism", words we all were taught to associate with evilness and enemies.

gjs278 8y ago

maybe you should have come to that conclusion on your own before wasting the doctors time

bequanna 8y ago

The armies of administrative workers: 1. https://www.advisory.com/daily-briefing/2018/07/23/administrative-costs https://www.advisory.com/daily-briefing/2018/07/23/administr... 2. https://www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/insight/expert-forum-rise-and-r...

war1025 8y ago

I just paid $1436 because we took our 1 year old son in when he had a stomach bug and they decided they needed to keep him for 24 hours for observation after giving him an IV to re-hydrate him. Glad he's okay, but if I knew we would be out $1500, I don't know that we would have taken him in.

asdf333 8y ago
this exactly. we need to change the system so prices are up front and something you can look up on the internet just like restaurant menus