Miscellaneous And Off Topic Subjects

[hack]

Everyone believes the other side's strategists are more focused, aggressive and tactically brilliant.

[Ghengis Jon]

Drug costs are a BIG part of the problem. The excuse that research costs alot (which it does) doesn't justify the gouging. A friend of mine's wife worked as a pharmy sales rep for four years. She traveled around to doctor's offices and hospital groups. Her smallest annual compensation was 300k/year. During her 4th year she got pregnant, downloaded, 'retired', and is happily a housemom. No profit margin in that industry.

I'm allergic to the fillers they put into all the generic and some name brand thyroid medication, so its full boat for me. $1.15 per pill is my cost where generics are 8 cents. My wife suffers from debilitating migraines. Pill form Imitrex has negligible effect but injection form works wonders. $95 per. Best part was migraines used to come 3/week.

If you require anything more than run of the mill medication, you're gonna get kicked.

[hack]

You need a trip to Mexico.

[Jeff Buchanan]

Drug costs are a BIG part of the problem......

They're really not. Only $0.09 of every health care dollar spent is for drugs. The biggest cost is in-patient hospital care at a whooping $0.32.

http://www.phrma.org/catalyst/the-re...n-three-charts.

What the exorbitant price of a drug represents in the medical economy is the unrestrained greed of big pharma. You've seen the stories. Something you may not have heard is the price of a single sitting for an infused chemotherapeutic agent for treating Non-Hodgkins Lymphoma - not a rare condition for the population of over 60s: $32K.

This is life saving treatment and big pharma is ripping insurance companies off and, in turn, they spread the costs out over their covered population. That's why a healthy family of four is paying upwards of $8K annually, sometimes more, for health insurance.

You've also heard of the horror stories about someone who has been in the hospital for a week and received a $100k bill for that stay. If you have Medicare coverage with no supplement - most of those earning under $50K annually who can't afford a Medicare supplement - just rang up a $20K debt. Oh, and BTW, can't pay medical bills is the single biggest cause of personal bankruptcy filing in the US.

Why are the hospitals charging these exorbitant fees? Simple. The board wants their hospital to be the best ..... like keeping up with and surpassing the Jones's and believe me this is big, big business. Note there are very few independent community hospitals left; they've all been bought by big corporations so, it's heavy weights duking it out here to sit on top of the mountain.

How much does a robotic surgery suite cost? The robot about $1.4m. The ancillary space and suite equipment costs, another $2-3 million. Robotic Prostrate surgery, a very common procedure, costs $6k more than the same surgery done without a robot and the evidence, although small sample size as robots are fairly new, doesn't do any better than a surgeon performing the same procedure without a robot. There is also increasing evidence that when complications do occur with robotic surgery, they are much more costly to treat to resolution...... of course, unless the patient dies and that is happening with alarming regularity.

So, hospital X wants a couple of these Robotic Surgery suites, right. The cost is amortized as a capital improvement on the books but you better believe a good accountant is going to recoup the entire cost of that suite by charging in-patients and by extension, insurance companies, huge sums for a week in the hospital.

Fixing health care, making it affordable and available to eligible citizens is not about rearranging deck chairs. The current system, including the ACA, is not efficient and a lot of that has to do with the crazy things that were done to the ACA during the legislative process of getting it into law ...... legislated into failure by BO's political opponents in congress some would say. Making health care work in the US is about coming up with moderate, bipartisan solutions like every other Western nation has done without the government imploding in debt.

[THE_WIZARD_]

ACA was about shifting the burden of healthcare costs from the poor to the middle class and rich. Plain and simple. Socialized medicine at it's worst. ACA is not sustainable either because doctors are going to start quitting due to the bullshit...and the rich are going to find a way to pass on the increases to them to consumers...and in the end it's the middle class that is going to take it up the piehole.

[hack]

You eat pie with your ass? Does OP know?

[entropy]

Jeff... I summed up the same rant in a couple of sentences... [emoji48]

Seriously... Good data and agree. Adding to a broken system doesn't improve it.


Sent from my iPad using Tapatalk

[froot loops]

My wife works in an ICU and routinely had to take care of a lot of patients who were considered self pay. Many of them were in there because they couldn't do any preventive care because they didn't have health insurance. Since the ACA some of the self pay stuff has subsided.

[Ghengis Jon]

Political correctness run amok. I blame Idi Amin, Michelle Bachman, and Crusty the Clown.

http://www.cnn.com/2016/03/31/living/white-dreadlocks-cultural-appropriation-feat/?iid=ob_homepage_deskrecommended_pool&iref=obnetwork

[Mike]

This micro aggression will not stand, man!

[Jeff Buchanan]

ACA was about shifting the burden of healthcare costs from the poor to the middle class and rich. Plain and simple. Socialized medicine at it's worst. ACA is not sustainable either because doctors are going to start quitting due to the bullshit...and the rich are going to find a way to pass on the increases to them to consumers...and in the end it's the middle class that is going to take it up the piehole.

I don't think there was an evil plot or a conspiracy engineered by those that took part in putting this bill together. The ACA didn't just happen in a few months time either with its underlying objective to transfer costs of it from one income group to another.

Tom Daschel co-wrote the 2008 book Critical: What We Can Do About the Health-Care Crisis. A lot of what he wrote showed up in the ACA. How you pay for a single payer system like was proposed in the book got a lot of attention. The pathway of the ACA from introduction to passage in Congress is a long story of how the bill was changed to avoid exactly what you speak of, Wiz.

The so called "Cadillac Tax," a tax that was intended to be levied on the top of the line health care plans that were considered to be too generous was one provision that got axed. It's intention was clearly to shift some of the cost of the ACA to upper income Americans who had this kind of coverage as well as to discourage insurance companies from issuing them.

[Jeff Buchanan]

....... because I've worked in it, I am familiar with exactly the kind of complaints associated with burdensome administrative tasks that providers have to put up with in the era of the ACA. However, most of these tasks don't involve those that are providing direct patient care but rather practice administrators who have to collect data and report it.

The sole practitioners get hit hardest by this. It is less apparent in large group practices affiliated with the big hospitals where admin staff are available to do this sort of thing. It is one reason, a very big one, why there aren't many solo practices any more. It's very difficult to run one profitably ....... and, overall, that may not be a bad thing.

Open a map on Google maps and search for medical practices in your local area. You'll likely get 100s of pins especially if you are in a metro area, not so much in rural areas. What impact do these 100s of practices have on continuity of patient care? I can assure you it is not positive. You've got 100s of docs with diverse objectives and no one talking to each other because all of them are trying to keep their practices open and running while competing for a single resource: patient's. Imaging Centers? Surgery Centers? The same thing. If you have ever had a diagnosis that required coordination with other specialists, you are familiar with the difficulty of negotiating the maze of providers you need to see, let alone which ones will take your insurance plan. There are ways to make patient care much more efficient and less costly.

In India, the national health care system is designed to co-locate specific services in a spoke and hub fashion. There is little redundancy which saves money. For example, let's say your primary care MD, located at the end of a spoke, has learned you have difficulty urinating and a screening test for prostate CA (PSA) is elevated. He has concerns for prostate CA. You are referred to a specialist (Urologist) a couple of levels up the spoke in the direction of the hub. He sees you, confirms the diagnosis and, to rule out metastasis, sends you further along the spoke towards the hub to an imaging center. Here, you get a PET Scan that shows no Metastasis. You move along to the hub (the end point for your care) which, in this case, is a surgical center. Here you receive the appropriate interventions, have immediate follow-up care then go back to your Primary Care Provider for additional follow-up care and monitoring.

Not saying the Indian model is a panacea. It isn't and it would be nearly impossible to introduce something like this in the US where stake holders would fight tooth and nail to keep their current piece of the pie. The model illuminates that there are ways to provide good continuity of care at a lower cost and also demonstrates how the current players in the US health care economy tend to work against such schemes.

[hack]

One thing to be careful of is the notion that if we change the system doctors will abandon their practices. That suggests that they will either no longer work or that they will be able to find a better place to work and go there. There aren't very many places at all -- IF ANY -- where practicing medicine is more profitable. And even if some were identified, it's not reasonable to assume that thousands of people who have settled lives and families etc are going uproot all that for a fatter profit margin, or that demand in those foreign places for health care is sufficient to absorb thousands of new doctors and overcome language and cultural barriers, etc.

[Jeff Buchanan]

Correct.

Physician pay is strikingly lower in countries where health care is nationalized. It should come as no surprise that the AMA is staunchly against a single payer system that would result in steep cuts in physician pay.

Keep in mind there are multiple hybrid healthcare systems. For example, in the UK, physicians typically are members of the National Health Service but also run fee for service practices on the side. In fact, the fee for services are more lucrative than their pay from the NHS. In this scenario, patient's pay up front for medical services rendered. There are insurance plans to cover these expenses but I'm not familiar enough with them to comment on how they might work. Canada has a similar system

These two countries have a two tiered system. One tier provides complete health care services to the population that wants to avail themselves of it. However, these tiers have a limited scope of what is provided. Care is essentially rationed. e.g., if you want a knee replacement done in tier one, you might have to wait your turn. If you jump to tier two, you can pay for it yourself and get it whenever you want. From what I know of the Canadian system, it is myth promulgated by opponents of a National Healthcare System in the US, that Canadians die waiting for services. That is just not an accurate portrayal. There may be delays but they are not unreasonable and in the case of life threatening conditions that have to be acted upon immediately, they are dealt with in the context of the National system.

[edindetroit]

My wife works in an ICU

So did Picabo Streets but they told her to stop answering the phone because it confused people when she answered "Picabo ICU".