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Bitter Pill: Why Medical Bills Are Killing Us

78 points by OGinparadise 14y ago

OldSchool 14y ago
The billing practices of medical providers in the US are appalling. I have seen statements where the "billed" amount was $15K and the "contract" amount actually paid (and accepted as full payment) was $1300 for one aspect of a one hour outpatient procedure. The $1300 seems reasonable considering the people and resources involved but the game of financially destroying people without insurance in a nation where people are denied independent coverage for something as trivial as allergies needs to end. Access to group health insurance alone can be reason enough to choose a corporate job over an entrepreneurial lifestyle once you have dependents.
viveutvivas 14y ago
The cherry on top: 100,000 Americans die from hospital-acquired infections each year.
OGinparadise 14y ago
like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly. A 20+ times difference? how can they justify it
- Shivetya 14y ago
  Because the government can force a cost upon a hospital that is not sustainable? Which in turn requires the hospital to recoup the costs elsewhere. One of the claims opponents have to ACA is that it will force private insurance out because the government will mandate its costs forcing private payers; companies and individual alike; to pick up the tab through higher billing from service providers. Still one has to flinch when you see the pay some NON doctors get. Then again, its the same in education too. Some of the highest paid people in public and college education are not educators.
  - sneak 14y ago
    The article addresses that. The real question is why new hospitals don't open up and charge less than these hyper-inflated retail rates and compete on price? I'm only on page 3, maybe that's addressed too - but I doubt it.
    - bhauer 14y ago
      I am going to go out on a limb and suggest barriers to entry. You don't just get a group of skilled doctors together and say, "let's make our own hospital!" Rent-seekers + regulation agencies = regulatory capture = barriers to entry = no competition.
      - carbocation 14y ago
        You essentially cannot, in the United States, get a group of doctors together to form a hospital as of the passage of Obama's healthcare reform act. (Technically, you can, but that facility cannot become Medicare certified, which is usually a death knell.) [1] [1] = http://www.ama-assn.org/amednews/2010/06/28/gvsa0628.htm http://www.ama-assn.org/amednews/2010/06/28/gvsa0628.htm
  - jdotjdot 14y ago
    But you also see absurd discounts with private insurance companies - - eg you get testing done by Quest and get an $1000 bill, and then the insurance discount is $900 before the insurer even pays anything. That's not the government forcing unsustainable pricing, that's simply nonsense. In no other industry is there such a difference between the sticker price and "discount", where those who can least afford to pay have to pay the most.
  - king_jester 14y ago
    > Because the government can force a cost upon a hospital that is not sustainable? Which in turn requires the hospital to recoup the costs elsewhere. Is this accurate? It was my understanding that payment practices with insurance providers is what causes the high sticker price of any given medicine or service in hospitals, even though insurance companies and programs like Medicare do not pay those prices, only those who pay out of pocket do.
- michaelochurch 14y ago
  A 20+ times difference? how can they justify it It's not right, but I know how they justify it. Health insurers negotiate a "discount" rate, that doctors tolerate for two reasons. The first is that the insurer will actually pay. The second is that, since insurers direct patients, they have leverage. One might call it extortion, in that the physician either needs to accept the insurer's rates, or end up "out of network" and get no patients from that insurer. Uninsured patients have no leverage, and the vast majority of them never pay their medical bills, so the people who do pay get marked up severely.
- lucidrains 14y ago
  You should contrast the cost of a CT/MRI here vs in other countries like India or Japan. The funny thing is, I ask healthcare professionals the same question and it is always just chalked up to the broken economics.
  - FireBeyond 14y ago
    Somewhat unsurprisingly, doctors who own an investment interest (or outright ownership of equipment / facility) are 3.7 times more likely to order CT/MRI scans. That is purely human "greed". I somehow doubt that self-selection of patients needing such imaging is occurring.
    - Tyr42 14y ago
      Well, or the doctor is interested and knowledgeable in MRI scans, which leads to both investment and more likely to use it as a tool.
      - FireBeyond 14y ago
        Which either says that other doctors are under-using MRI scans (doubtful, the US orders more CT/MRI scans per capita than any other country on earth by nearly seventy per cent, which to say that doctors elsewhere should be doing up to six times more), or that they're exploring their own "interest" at the cost of the consumer.
- OGinparadise 14y ago
  my math was off --a little :)--but still
deleted 14y ago
[deleted]
skore 14y ago
A very good article that reminds me of an understanding that I've come to a couple of years ago - that free market capitalism and health care just don't mix. Having the option to choose against a service, or being physically able to choose another service vendor if one is ripping you off are some of the core rules keeping the worst absurdities of capitalism in check. Without them, the result is that people are being held hostage - pay here or die here. People aren't usually inclined to choose the second.
- jpadkins 14y ago
  How is the US Healthcare system in anyway like a free market? It's by far the most heavily regulated industry, every aspect of it. I believe government pays ~ 1/3rd of all healthcare costs. Free market healthcare is veterinary, plastic surgery, lasik or maybe even dentists. Those sectors haven't seen skyrocketing costs.
  - michaelochurch 14y ago
    Corporate capitalism exists to provide the best of socialism and capitalism for the well-connected, entitled corporate elite and the worst of both systems for everyone else.
    - Roboprog 14y ago
      Odd, I prefer the term "corporate communism" for monopoly/oligarchy: A central board plans some aspect of the economy, just like Soviet Russia, once you get to a monopoly, with similar efficiencies. Anyway, the US would probably benefit from a hybrid system: government provided baseline care with option to purchase private upgrades.
  - hamburglar 14y ago
    You have apparently never been handed a $93k estimate for dental work, and are probably not aware that it is nearly impossible to find a dental plan that will pay for more than a couple thousand dollars of work (they all have caps that can easily be exceeded by getting work done on a single tooth).
michaelochurch 14y ago
Private health insurance and hospital bills are a brilliant, evil robbery. Who is least likely to fight back against robbery? Sick people. Health insurers get the best part of the deal. Knowing that sick people often don't have jobs and, as a group, rarely have money, they take the money when people are well.
DanielBMarkham 14y ago
Very interesting case study in how simple changes lead to emergent complex systems. Who would have thought that taking health insurance away from the person and assigning it to the employer would lead here? With every band-aid we put on the system, it just flows around and makes itself more complex. All of these systems, the paymaster, the insurance companies, the employers, the drug companies, the trial lawyers, etc -- they live in an ecosystem we have created over time. This ecosystem was continually adjusted to solve one problem, thereby creating more complexity for all other areas. For that reason, I do not believe a list of remedies is the way to go here. Especially trying to increase hospital taxes -- that has as much chance of working as spitting in the ocean increasing global sea levels. Whatever we do, we have to fight the complexity actively -- even if it doesn't directly lower costs. We can understand these things as basic software architecture principles. A couple of small suggestions: - Eliminate needless architectural tiers. Make it illegal for anybody but the patient to pay healthcare providers. If you have insurance, fine. The insurance company pays you, then you pay the provider. - Decouple the hospital (building and administrative staff) from the services being provided - Standardize components. Mandate that all services provided must be in a free and open market. That means open pricing (bidding), public consumer reporting, outsourcing if possible, and so forth. - Require interoperability. One provider cannot require that another provider be used. It's the provider's responsibility to interface with other providers - Establish naming conventions You get the idea. The point here is that we've been playing whack-a-mole. Some guy goes out and writes a wonderful article about the complexities and problems with the market. So new adjustments are made to fix them. They only create more problems, which some other guy goes out and writes about. Each iteration may take many years. Over time the amount of cruft and inefficiencies is staggering. If we continue with this strategy of fixing the problem it's just going to get worse. This method of problem solving hurts. Let's not do that anymore.
- jivatmanx 14y ago
  I'd add, the cost of medical education before one can practice in the U.S. has multiplied over the years and seems excessive compared to Europe, where medicine is traditionally a 6-year undergraduate program. As a result, doctors needs to get paid far more, especially specialists.
rogerbinns 14y ago
It amuses me that the US is considered the land of free markets and competition. The complete opposite is the case for hospitals. For example if you wanted to open a new hospital that is more cost effective you most probably couldn't. You would have to get a certificate of need which essentially ensures that the existing hospitals remain profitable. http://en.wikipedia.org/wiki/Certificate_of_need http://en.wikipedia.org/wiki/Certificate_of_need Due to most health care being employer based or provided by the government (medicare/caid, military, veterans etc) there isn't really any individual choice, and you can't really take your business elsewhere.
marknutter 14y ago
I blame a large part of our problems on barriers to entry for the medical field. The AMA keeps doctor supplies artificially low and there's an enormous amount of red tape involved with providing medical services to people. The lower the barriers are for an industry, the higher the innovation and efficiency. Although, lower regulation does mean more risk for the consumer, so the game becomes making it easy for the consumer to navigate a risky terrain.
JumpCrisscross 14y ago
A significant step forward would be requiring hospitals to disclose the cost of each procedure and then aggregating those data at the state and national levels. The marginal cost for this compliance should not be astronomical, given they're already itemising receipts. Or is there a Medicare cost database?
- refurb 14y ago
  This is exactly what Castlight Health is doing. They are collecting cost and outcome data and partnering with employers to setup the most cost effective insurance they can.
dougk16 14y ago
I live in the US and am currently in Poland with my wife and 1-year-old visiting friends and family. Shortly after arriving, my son got a bad enough fever that we sought medical care. This past Monday night, at 9PM, an hour after the call, in the suburbs of a mid-sized city, a doctor came to our house and treated him (he's fine now). Cost us 140 zlots, or about 45 bucks. No bullshit paperwork where you fill out your name and address 4 times either...quick, professional, in and out. I experience situations like this again and again while travelling abroad from the US, but this one put me in shock.
- danielharan 14y ago
  It seems... civilized.
- OGinparadise 14y ago
  Yes, but how much is $45 in Poland? You can find clinics in USA that treat you for a flat $50-$100 fee, problem is specialized care.
  - gambiting 14y ago
    It's an equivalent of 2 days of work for an average person. But my dad had to have few operations for cancer,and now takes a very expensive drug called Glivec($3000 for a box of 30 pills, needs two boxes per month), everything is completely refunded by the government as a part of public health care. He also needs to travel to Warsaw at least once per month to pick up his medicine from the hospital there(you can only do it in person because of how much it costs), which means he has to take a 4 hour train journey - he gets it completely refunded.
  - dougk16 14y ago
    Fair enough point...it's actually more like ~$100 in a relative sense, as far as my working experience in Poland went. But even saying it's the same relative price as in America, consider that this is a foreigner, calling at 8PM for a 9PM home appointment, very quick paperwork, and cash payment like the doctor delivered a pizza (we even tipped her). Everyone else here that I know has public healthcare that's largely reimbursed, so they were actually appalled by the price...go figure.
anuraj 14y ago
India had a process patent regime earlier. The result - generic rituximab costs around 0.7$ in the country. Compare it with the story where the price was $13702. http://www.healthkartplus.com/details/drugs/30975/reditux-500-mg http://www.healthkartplus.com/details/drugs/30975/reditux-50...
Futurebot 14y ago
"If you could figure out a way to pay doctors better and separately fund research … adequately, I could see where a single-payer approach would be the most logical solution,” says Gunn, Sloan-Kettering’s chief operating officer. “It would certainly be a lot more efficient than hospitals like ours having hundreds of people sitting around filling out dozens of different kinds of bills for dozens of insurance companies.” Maybe, but the prospect of overhauling our system this way, displacing all the private insurers and other infrastructure after all these decades, isn’t likely. For there would be one group of losers — and these losers have lots of clout." A big lesson here is that once you create an industry - no matter how destructive it turns out to be - you cannot easily get rid of it without huge political costs due to the number of people who would wind up unemployed if you got rid of said system/industry (and who would wind up hating your and your political party, which may mean you start losing elections.) Who is going to risk that except for fanatics?
toolslive 14y ago
An economist called Akerlof has shown in 1970 that markets whose players have asymmetric information are doomed. The private health insurance market is a well known example of this. http://en.wikipedia.org/wiki/The_Market_for_Lemons http://en.wikipedia.org/wiki/The_Market_for_Lemons
gambiting 14y ago
As a person coming from a EU country, I have absolutely no words for this. Like seriously, what the actual fuck America?? You will fight to the death to preserve your right to bear weapons,but any suggestion to make health care public and not let idiotic situations like this happen are fought with ferocity. What the hell.
- astrodust 14y ago
  If only the Second Amendment was "A healthy and fit population being necessary to the security of a free state, the right of the people to universal health-care shall not be infringed."
FireBeyond 14y ago
As an EMS provider, I see the same thing. I saw a man the other night who was "sick". An older gentleman, not a "frequent flier", but someone who genuinely should be in the hospital. He was suffering dizziness, and had passed out getting out of bed, and was now experiencing abnormally high blood pressure, a racing pulse, and while an ECG was clear, there was concern over heart issues. I suggested we take him to the hospital. He refused. "I can't afford that. They're already chasing me for $16,000". He worried that they'd refuse to treat him. I informed him that legally, they were obligated to, but of course that would cost money. In the end, he stayed home. His wife promised to either call us again if he got particularly worse, but both of them were reluctant, even then, for him to go via ambulance - "At least that way we can save about $1,000". It is a sad day in a civilized, modern society when fundamental decisions on healthcare are made purely on finances, not quality of life.
- jrogers65 14y ago
  > It is a sad day in a civilized, modern society when fundamental decisions on healthcare are made purely on finances, not quality of life. I don't understand how you were sold on the idea that you are in a civilised society when one of the fundamental aspects of living in one is that your neighbours will help you when you can't help yourself.
booz 14y ago
This part really upset me - "Unlike those of almost any other area we can think of, the dynamics of the medical marketplace seem to be such that the advance of technology has made medical care more expensive, not less. First, it appears to encourage more procedures and treatment by making them easier and more convenient. (This is especially true for procedures like arthroscopic surgery.) Second, there is little patient pushback against higher costs because it seems to (and often does) result in safer, better care and because the customer getting the treatment is either not going to pay for it or not going to know the price until after the fact."

78 points by OGinparadise 14y ago

The billing practices of medical providers in the US are appalling. I have seen statements where the "billed" amount was $15K and the "contract" amount actually paid (and accepted as full payment) was $1300 for one aspect of a one hour outpatient procedure. The $1300 seems reasonable considering the people and resources involved but the game of financially destroying people without insurance in a nation where people are denied independent coverage for something as trivial as allergies needs to end. Access to group health insurance alone can be reason enough to choose a corporate job over an entrepreneurial lifestyle once you have dependents.

viveutvivas 14y ago

The cherry on top: 100,000 Americans die from hospital-acquired infections each year.

OGinparadise 14y ago

like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly. A 20+ times difference? how can they justify it

Shivetya 14y ago
Because the government can force a cost upon a hospital that is not sustainable? Which in turn requires the hospital to recoup the costs elsewhere. One of the claims opponents have to ACA is that it will force private insurance out because the government will mandate its costs forcing private payers; companies and individual alike; to pick up the tab through higher billing from service providers. Still one has to flinch when you see the pay some NON doctors get. Then again, its the same in education too. Some of the highest paid people in public and college education are not educators.
- sneak 14y ago
  The article addresses that. The real question is why new hospitals don't open up and charge less than these hyper-inflated retail rates and compete on price? I'm only on page 3, maybe that's addressed too - but I doubt it.
  - bhauer 14y ago
    I am going to go out on a limb and suggest barriers to entry. You don't just get a group of skilled doctors together and say, "let's make our own hospital!" Rent-seekers + regulation agencies = regulatory capture = barriers to entry = no competition.
    - carbocation 14y ago
      You essentially cannot, in the United States, get a group of doctors together to form a hospital as of the passage of Obama's healthcare reform act. (Technically, you can, but that facility cannot become Medicare certified, which is usually a death knell.) [1] [1] = http://www.ama-assn.org/amednews/2010/06/28/gvsa0628.htm http://www.ama-assn.org/amednews/2010/06/28/gvsa0628.htm
- jdotjdot 14y ago
  But you also see absurd discounts with private insurance companies - - eg you get testing done by Quest and get an $1000 bill, and then the insurance discount is $900 before the insurer even pays anything. That's not the government forcing unsustainable pricing, that's simply nonsense. In no other industry is there such a difference between the sticker price and "discount", where those who can least afford to pay have to pay the most.
- king_jester 14y ago
  > Because the government can force a cost upon a hospital that is not sustainable? Which in turn requires the hospital to recoup the costs elsewhere. Is this accurate? It was my understanding that payment practices with insurance providers is what causes the high sticker price of any given medicine or service in hospitals, even though insurance companies and programs like Medicare do not pay those prices, only those who pay out of pocket do.
michaelochurch 14y ago
A 20+ times difference? how can they justify it It's not right, but I know how they justify it. Health insurers negotiate a "discount" rate, that doctors tolerate for two reasons. The first is that the insurer will actually pay. The second is that, since insurers direct patients, they have leverage. One might call it extortion, in that the physician either needs to accept the insurer's rates, or end up "out of network" and get no patients from that insurer. Uninsured patients have no leverage, and the vast majority of them never pay their medical bills, so the people who do pay get marked up severely.
lucidrains 14y ago
You should contrast the cost of a CT/MRI here vs in other countries like India or Japan. The funny thing is, I ask healthcare professionals the same question and it is always just chalked up to the broken economics.
- FireBeyond 14y ago
  Somewhat unsurprisingly, doctors who own an investment interest (or outright ownership of equipment / facility) are 3.7 times more likely to order CT/MRI scans. That is purely human "greed". I somehow doubt that self-selection of patients needing such imaging is occurring.
  - Tyr42 14y ago
    Well, or the doctor is interested and knowledgeable in MRI scans, which leads to both investment and more likely to use it as a tool.
    - FireBeyond 14y ago
      Which either says that other doctors are under-using MRI scans (doubtful, the US orders more CT/MRI scans per capita than any other country on earth by nearly seventy per cent, which to say that doctors elsewhere should be doing up to six times more), or that they're exploring their own "interest" at the cost of the consumer.
OGinparadise 14y ago
my math was off --a little :)--but still

deleted 14y ago

[deleted]

skore 14y ago

A very good article that reminds me of an understanding that I've come to a couple of years ago - that free market capitalism and health care just don't mix. Having the option to choose against a service, or being physically able to choose another service vendor if one is ripping you off are some of the core rules keeping the worst absurdities of capitalism in check. Without them, the result is that people are being held hostage - pay here or die here. People aren't usually inclined to choose the second.

jpadkins 14y ago
How is the US Healthcare system in anyway like a free market? It's by far the most heavily regulated industry, every aspect of it. I believe government pays ~ 1/3rd of all healthcare costs. Free market healthcare is veterinary, plastic surgery, lasik or maybe even dentists. Those sectors haven't seen skyrocketing costs.
- michaelochurch 14y ago
  Corporate capitalism exists to provide the best of socialism and capitalism for the well-connected, entitled corporate elite and the worst of both systems for everyone else.
  - Roboprog 14y ago
    Odd, I prefer the term "corporate communism" for monopoly/oligarchy: A central board plans some aspect of the economy, just like Soviet Russia, once you get to a monopoly, with similar efficiencies. Anyway, the US would probably benefit from a hybrid system: government provided baseline care with option to purchase private upgrades.
- hamburglar 14y ago
  You have apparently never been handed a $93k estimate for dental work, and are probably not aware that it is nearly impossible to find a dental plan that will pay for more than a couple thousand dollars of work (they all have caps that can easily be exceeded by getting work done on a single tooth).

michaelochurch 14y ago

Private health insurance and hospital bills are a brilliant, evil robbery. Who is least likely to fight back against robbery? Sick people. Health insurers get the best part of the deal. Knowing that sick people often don't have jobs and, as a group, rarely have money, they take the money when people are well.

DanielBMarkham 14y ago

Very interesting case study in how simple changes lead to emergent complex systems. Who would have thought that taking health insurance away from the person and assigning it to the employer would lead here? With every band-aid we put on the system, it just flows around and makes itself more complex. All of these systems, the paymaster, the insurance companies, the employers, the drug companies, the trial lawyers, etc -- they live in an ecosystem we have created over time. This ecosystem was continually adjusted to solve one problem, thereby creating more complexity for all other areas. For that reason, I do not believe a list of remedies is the way to go here. Especially trying to increase hospital taxes -- that has as much chance of working as spitting in the ocean increasing global sea levels. Whatever we do, we have to fight the complexity actively -- even if it doesn't directly lower costs. We can understand these things as basic software architecture principles. A couple of small suggestions: - Eliminate needless architectural tiers. Make it illegal for anybody but the patient to pay healthcare providers. If you have insurance, fine. The insurance company pays you, then you pay the provider. - Decouple the hospital (building and administrative staff) from the services being provided - Standardize components. Mandate that all services provided must be in a free and open market. That means open pricing (bidding), public consumer reporting, outsourcing if possible, and so forth. - Require interoperability. One provider cannot require that another provider be used. It's the provider's responsibility to interface with other providers - Establish naming conventions You get the idea. The point here is that we've been playing whack-a-mole. Some guy goes out and writes a wonderful article about the complexities and problems with the market. So new adjustments are made to fix them. They only create more problems, which some other guy goes out and writes about. Each iteration may take many years. Over time the amount of cruft and inefficiencies is staggering. If we continue with this strategy of fixing the problem it's just going to get worse. This method of problem solving hurts. Let's not do that anymore.

jivatmanx 14y ago
I'd add, the cost of medical education before one can practice in the U.S. has multiplied over the years and seems excessive compared to Europe, where medicine is traditionally a 6-year undergraduate program. As a result, doctors needs to get paid far more, especially specialists.

rogerbinns 14y ago

It amuses me that the US is considered the land of free markets and competition. The complete opposite is the case for hospitals. For example if you wanted to open a new hospital that is more cost effective you most probably couldn't. You would have to get a certificate of need which essentially ensures that the existing hospitals remain profitable. http://en.wikipedia.org/wiki/Certificate_of_need http://en.wikipedia.org/wiki/Certificate_of_need Due to most health care being employer based or provided by the government (medicare/caid, military, veterans etc) there isn't really any individual choice, and you can't really take your business elsewhere.

marknutter 14y ago

I blame a large part of our problems on barriers to entry for the medical field. The AMA keeps doctor supplies artificially low and there's an enormous amount of red tape involved with providing medical services to people. The lower the barriers are for an industry, the higher the innovation and efficiency. Although, lower regulation does mean more risk for the consumer, so the game becomes making it easy for the consumer to navigate a risky terrain.

JumpCrisscross 14y ago

A significant step forward would be requiring hospitals to disclose the cost of each procedure and then aggregating those data at the state and national levels. The marginal cost for this compliance should not be astronomical, given they're already itemising receipts. Or is there a Medicare cost database?

refurb 14y ago
This is exactly what Castlight Health is doing. They are collecting cost and outcome data and partnering with employers to setup the most cost effective insurance they can.

dougk16 14y ago

I live in the US and am currently in Poland with my wife and 1-year-old visiting friends and family. Shortly after arriving, my son got a bad enough fever that we sought medical care. This past Monday night, at 9PM, an hour after the call, in the suburbs of a mid-sized city, a doctor came to our house and treated him (he's fine now). Cost us 140 zlots, or about 45 bucks. No bullshit paperwork where you fill out your name and address 4 times either...quick, professional, in and out. I experience situations like this again and again while travelling abroad from the US, but this one put me in shock.

danielharan 14y ago
It seems... civilized.
OGinparadise 14y ago
Yes, but how much is $45 in Poland? You can find clinics in USA that treat you for a flat $50-$100 fee, problem is specialized care.
- gambiting 14y ago
  It's an equivalent of 2 days of work for an average person. But my dad had to have few operations for cancer,and now takes a very expensive drug called Glivec($3000 for a box of 30 pills, needs two boxes per month), everything is completely refunded by the government as a part of public health care. He also needs to travel to Warsaw at least once per month to pick up his medicine from the hospital there(you can only do it in person because of how much it costs), which means he has to take a 4 hour train journey - he gets it completely refunded.
- dougk16 14y ago
  Fair enough point...it's actually more like ~$100 in a relative sense, as far as my working experience in Poland went. But even saying it's the same relative price as in America, consider that this is a foreigner, calling at 8PM for a 9PM home appointment, very quick paperwork, and cash payment like the doctor delivered a pizza (we even tipped her). Everyone else here that I know has public healthcare that's largely reimbursed, so they were actually appalled by the price...go figure.

anuraj 14y ago

India had a process patent regime earlier. The result - generic rituximab costs around 0.7$ in the country. Compare it with the story where the price was $13702. http://www.healthkartplus.com/details/drugs/30975/reditux-500-mg http://www.healthkartplus.com/details/drugs/30975/reditux-50...

Futurebot 14y ago

"If you could figure out a way to pay doctors better and separately fund research … adequately, I could see where a single-payer approach would be the most logical solution,” says Gunn, Sloan-Kettering’s chief operating officer. “It would certainly be a lot more efficient than hospitals like ours having hundreds of people sitting around filling out dozens of different kinds of bills for dozens of insurance companies.” Maybe, but the prospect of overhauling our system this way, displacing all the private insurers and other infrastructure after all these decades, isn’t likely. For there would be one group of losers — and these losers have lots of clout." A big lesson here is that once you create an industry - no matter how destructive it turns out to be - you cannot easily get rid of it without huge political costs due to the number of people who would wind up unemployed if you got rid of said system/industry (and who would wind up hating your and your political party, which may mean you start losing elections.) Who is going to risk that except for fanatics?

toolslive 14y ago

An economist called Akerlof has shown in 1970 that markets whose players have asymmetric information are doomed. The private health insurance market is a well known example of this. http://en.wikipedia.org/wiki/The_Market_for_Lemons http://en.wikipedia.org/wiki/The_Market_for_Lemons

gambiting 14y ago

As a person coming from a EU country, I have absolutely no words for this. Like seriously, what the actual fuck America?? You will fight to the death to preserve your right to bear weapons,but any suggestion to make health care public and not let idiotic situations like this happen are fought with ferocity. What the hell.

astrodust 14y ago
If only the Second Amendment was "A healthy and fit population being necessary to the security of a free state, the right of the people to universal health-care shall not be infringed."

FireBeyond 14y ago

As an EMS provider, I see the same thing. I saw a man the other night who was "sick". An older gentleman, not a "frequent flier", but someone who genuinely should be in the hospital. He was suffering dizziness, and had passed out getting out of bed, and was now experiencing abnormally high blood pressure, a racing pulse, and while an ECG was clear, there was concern over heart issues. I suggested we take him to the hospital. He refused. "I can't afford that. They're already chasing me for $16,000". He worried that they'd refuse to treat him. I informed him that legally, they were obligated to, but of course that would cost money. In the end, he stayed home. His wife promised to either call us again if he got particularly worse, but both of them were reluctant, even then, for him to go via ambulance - "At least that way we can save about $1,000". It is a sad day in a civilized, modern society when fundamental decisions on healthcare are made purely on finances, not quality of life.

jrogers65 14y ago
> It is a sad day in a civilized, modern society when fundamental decisions on healthcare are made purely on finances, not quality of life. I don't understand how you were sold on the idea that you are in a civilised society when one of the fundamental aspects of living in one is that your neighbours will help you when you can't help yourself.

booz 14y ago

This part really upset me - "Unlike those of almost any other area we can think of, the dynamics of the medical marketplace seem to be such that the advance of technology has made medical care more expensive, not less. First, it appears to encourage more procedures and treatment by making them easier and more convenient. (This is especially true for procedures like arthroscopic surgery.) Second, there is little patient pushback against higher costs because it seems to (and often does) result in safer, better care and because the customer getting the treatment is either not going to pay for it or not going to know the price until after the fact."