5 ms·

Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Of course, reimbursem

Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Of course, reimbursement rates are hardly our only problem. We also use more expensive treatment options for the same conditions, give doctors (and thus patients) a level of flexibility unheard of elsewhere that allows to spend money on unnecessary medicine just to make a patient happy and have ridiculous administrative overhead costs.

coredog64 7y ago
We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo.
- subhobroto 7y ago
  Not really. You tell the working parents that they can deliver the baby in the shared room for no additional cost or upgrade to the private suite for $100k.
  - projektfu 7y ago
    What are you trying to say? It wasn’t clear.
    - sah2ed 7y ago
      Perhaps that the actual cost to use private rooms for delivery is being subsidized?
      - subhobroto 7y ago
        I did not mean exactly that, but this happens too. Not every new parent can afford the expense of birth. So the hospitals try and squeeze out as much as they can from every party to try and even it out. As a high income earner, I'm specially vulnerable to this practice. No judge or newspaper or activist has particular empathy that I got charged $200k for a delivery or $6k for an 2 mile ambulance ride. I can afford to pay it so why am I being so picky about it?
        stolsvik 7y ago
        Are you serious with the $200k?!?
        subhobroto 7y ago
        You seem surprised. It's such a regular occurrence that it does not make news anymore. Much higher amounts make the news now: https://www.theguardian.com/us-news/2018/jan/16/why-does-it-cost-32093-just-to-give-birth-in-america https://www.theguardian.com/us-news/2018/jan/16/why-does-it-... https://www.cbc.ca/news/canada/saskatoon/jennifer-huculak-kimmel-billed-950k-us-after-giving-birth-in-u-s-1.2839319 https://www.cbc.ca/news/canada/saskatoon/jennifer-huculak-ki...
    - subhobroto 7y ago
      See, the OP said: > We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo. If I was a patient at a hospital, I would not be able to control this: > We overtrain docs That part is outside my control. ... but, I, as a patient at a hospital, would be able to control this: > we’ve built hospitals that focus on private rooms instead of wards Infact, some of hopitals in the U.S. do have ward deliveries - I believe Kaiser Permanente have shared rooms? However, that is the rub - people are not explicitly requesting private rooms - hospitals just have them so they can charge as much as they can. If you walk into a hospital, you cant ask to have a ward delivery. They take you to a private room by default - no questions asked. That's all they have. Then the bill comes and the game begins - if the insurance company does not pay, the hospital will then come after you. They will put you on a payment plan. If you can't make payments, they will sell you to collections. Some hospitals might settle for an upfront cash payment but then it cannot go through your insurance and you are out of money AND you did not meet your family deductible either. If there was a choice to new parents between ward deliveries for $50k and private rooms for $150k, I know which one I would take. I don't have that choice because my employer might not be offering care though Kaiser Permanente and the hospitals in network might only have private rooms. So change employers because I prefer ward deliveries?
      - projektfu 7y ago
        OK thanks. I was confused. I thought you were saying patients wouldn't accept shared rooms and this is built into our cost structure.
        subhobroto 7y ago
        My pleasure. Thank you for pointing out where I can end up confusing a reader. I write occasionally. Example: https://www.quora.com/Do-all-citizens-have-a-right-to-affordable-health-care/answer/Subhobroto-Sinha-1 https://www.quora.com/Do-all-citizens-have-a-right-to-afford...
nanis 7y ago
> Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Medicare's reimbursement rates could just as well be published by Gosplan. If you squint hard enough, they are almost an application of the Labor Theory of Value: There is an intrinsic value of everything determined by how much labor went into producing it. That, of course, leads to all sorts of fun stuff like seniors in Florida loading up on cosmetic surgery and ED medication on the backs of the younger generations.
- zxcmx 7y ago
  So with true state provided healthcare: The “price” is really just the unit cost. Companies seem to have no problem computing unit costs (and thus margins!), no gosplan-like apparatus is required for this beyond supply-chain management and accounting. The U.S. situation is complicated considerably by all the different parties involved which I guess is why this idea might work less well there. Correspondingly I suppose the “true value” would be the value provided to the recipient of the procedure and society as a whole, and as you observe is much more subjective and probably best not even measured in dollars. I think “quality of life adjusted years” is a thing. The major problem is when the you and the state disagree on the value of a procedure and whether it justifies the costs... Another way to look at it, “socialised medicine” is just health insurance collected by the state with full vertical integration; your insurer also runs the hospitals and provides the care. The upside is you’re covered, the downside is you don’t get to choose a plan.

coredog64 7y ago

We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo.

subhobroto 7y ago
Not really. You tell the working parents that they can deliver the baby in the shared room for no additional cost or upgrade to the private suite for $100k.
- projektfu 7y ago
  What are you trying to say? It wasn’t clear.
  - sah2ed 7y ago
    Perhaps that the actual cost to use private rooms for delivery is being subsidized?
    - subhobroto 7y ago
      I did not mean exactly that, but this happens too. Not every new parent can afford the expense of birth. So the hospitals try and squeeze out as much as they can from every party to try and even it out. As a high income earner, I'm specially vulnerable to this practice. No judge or newspaper or activist has particular empathy that I got charged $200k for a delivery or $6k for an 2 mile ambulance ride. I can afford to pay it so why am I being so picky about it?
      - stolsvik 7y ago
        Are you serious with the $200k?!?
        subhobroto 7y ago
        You seem surprised. It's such a regular occurrence that it does not make news anymore. Much higher amounts make the news now: https://www.theguardian.com/us-news/2018/jan/16/why-does-it-cost-32093-just-to-give-birth-in-america https://www.theguardian.com/us-news/2018/jan/16/why-does-it-... https://www.cbc.ca/news/canada/saskatoon/jennifer-huculak-kimmel-billed-950k-us-after-giving-birth-in-u-s-1.2839319 https://www.cbc.ca/news/canada/saskatoon/jennifer-huculak-ki...
  - subhobroto 7y ago
    See, the OP said: > We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo. If I was a patient at a hospital, I would not be able to control this: > We overtrain docs That part is outside my control. ... but, I, as a patient at a hospital, would be able to control this: > we’ve built hospitals that focus on private rooms instead of wards Infact, some of hopitals in the U.S. do have ward deliveries - I believe Kaiser Permanente have shared rooms? However, that is the rub - people are not explicitly requesting private rooms - hospitals just have them so they can charge as much as they can. If you walk into a hospital, you cant ask to have a ward delivery. They take you to a private room by default - no questions asked. That's all they have. Then the bill comes and the game begins - if the insurance company does not pay, the hospital will then come after you. They will put you on a payment plan. If you can't make payments, they will sell you to collections. Some hospitals might settle for an upfront cash payment but then it cannot go through your insurance and you are out of money AND you did not meet your family deductible either. If there was a choice to new parents between ward deliveries for $50k and private rooms for $150k, I know which one I would take. I don't have that choice because my employer might not be offering care though Kaiser Permanente and the hospitals in network might only have private rooms. So change employers because I prefer ward deliveries?
    - projektfu 7y ago
      OK thanks. I was confused. I thought you were saying patients wouldn't accept shared rooms and this is built into our cost structure.
      - subhobroto 7y ago
        My pleasure. Thank you for pointing out where I can end up confusing a reader. I write occasionally. Example: https://www.quora.com/Do-all-citizens-have-a-right-to-affordable-health-care/answer/Subhobroto-Sinha-1 https://www.quora.com/Do-all-citizens-have-a-right-to-afford...

nanis 7y ago

> Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Medicare's reimbursement rates could just as well be published by Gosplan. If you squint hard enough, they are almost an application of the Labor Theory of Value: There is an intrinsic value of everything determined by how much labor went into producing it. That, of course, leads to all sorts of fun stuff like seniors in Florida loading up on cosmetic surgery and ED medication on the backs of the younger generations.

zxcmx 7y ago
So with true state provided healthcare: The “price” is really just the unit cost. Companies seem to have no problem computing unit costs (and thus margins!), no gosplan-like apparatus is required for this beyond supply-chain management and accounting. The U.S. situation is complicated considerably by all the different parties involved which I guess is why this idea might work less well there. Correspondingly I suppose the “true value” would be the value provided to the recipient of the procedure and society as a whole, and as you observe is much more subjective and probably best not even measured in dollars. I think “quality of life adjusted years” is a thing. The major problem is when the you and the state disagree on the value of a procedure and whether it justifies the costs... Another way to look at it, “socialised medicine” is just health insurance collected by the state with full vertical integration; your insurer also runs the hospitals and provides the care. The upside is you’re covered, the downside is you don’t get to choose a plan.