The $2.7 Trillion Medical Bill

Why our ablations (and colonoscopies et al) cost so much more than anywhere else

[www.nytimes.com]

It's highway robbery! Free market, my patootie.

There was an excellent article in Time magazine about this a couple of months ago, by Steven Brill [www.time.com]

The profits support highly paid executives and dividends to shareholders.

All healthcare should be non-profit.

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Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

Health care in the US, especially California is so high due to lawsuits and huge executive salaries. Being a not for profit hospital doesn’t keep healthcare costs down. Check out some of the huge executive salaries and profits these “not for profit hospitals make”. I believe to be a non-profit only requires a small percentage of underserved patients, it’s ridiculous.

Valli

That doesn't appear to be so. Look at the details of the billing in the NY Times and Time magazine articles. The prices are arbitrary, there's no basis for them. Medicare negotiates payments for only a fraction of the bill, and the hospitals do fine with that. The Time magazine article in particular explains this.

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Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

Latrogenia:

All healthcare should be non-profit., this is what you said. Do you want doctors to get low pay as well as everybody connected to the healthcare industry, I believe in a fair wage for all. Doctors charge more for everything when their patient is on medicare because they know that the charge will be reduced. Free market isn't allowed in the health insurance industry, you cannot buy health Ins. across state lines, a lot of times the insurance you have to buy in your state has a lot of things in it that we don't need which makes the ins. higher. Hospitals and doctors do not to do fine with medicare payments, many doctors are retiring early and those that are not. aren't taking new medicare patients.

I am not saying that our healthcare isn't expensive, it is, there are a lot of reasons, there are too many tests that aren't necessary, but the doctor orders them because fear of being sued. Our health ins. is very high and it has gone up because of the new healthcare law. We do need changes but what is coming down the pike isn't it.

Any single payer medical insurance plan can only increase rates for all since there is no competition and therefore no reason to be efficient, fair or responsible, as the patient has no choice to pay whatever asked, by legislation.

California is looking at up to a 146% increase in health insurance premiums this year; one of the reasons being that several of the large medical insurance companies are dropping out of doing business in the state and the few remaining have agreed to get in line and play the game. [www.forbes.com]

Gordon

I don't know what the answer is. I know a lot of people in England swear by the National Health Service there but I have seen how it worked out for my parents first-hand and it wasn't pretty.



Edited 1 time(s). Last edit at 06/03/2013 10:53AM by afhound99.

I urge everyone to read both articles. It's quite obvious doctors can be paid fairly in a non-profit environment. It's also obvious that overuse by patients is not the central problem.

The central problem is that pricing is opaque and the system is gamed by hospitals and quasi-surgical centers.

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Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

I've always been frustrated about the inability to get a firm price before getting a procedure. If you can get firm quote on an ablation in Bordeaux, there is no reason why you can't get one on a whole range of procedures here in the states. I've had very high deductible insurance for over 25 years so am very aware of the full price of what I get. It is difficult to have competition between providers if you can't compare prices.

When my daughter was born 23 years ago, we pre-negotiated a price with the hospital (about 1/3 the "list" price). They did not want to give us that price if we had insurance nor did they want to give us an itemized bill, which the insurance required to pay on. I did manage to get the itemized bill, but it was not easy. Then I had to go to the state's insurance commission to get the insurance company to actually pay. It shouldn't have to be this difficult to have market forces actually at work.

Bottom line, bottom line, botton line...i.e. if all parties involved---especially patients---were aware and accountable to each and every procedural cost, then trust me, healthcare costs would be much lower. Medicare mandates, a lack of real private insurance competition, and the fear of Doctor Smith being sued all within the guise of non-accountablility (right hand, left hand) is what's choking American healthcare.

It's called a cartel. Fortunately in Canada we have public medicine that has worked, but is on a crash course. A layer of competitive free market health providers is now being allowed and so far it is working. But our dental system stinks of cartel. You can't get around their fixed pricing other than to go outside of the country as a medical tourist. When I am comfortable that everything is in order with the afib I plan to make money by going for a holiday to Costa Rica for some dental work.

Hope the dentists in Costa Rica are good dentists---I have a great dentist, who I trust, he is expensive but sometimes cheaper doesn't always turn out all that well.

Liz

Liz - I'm glad you have a good dentist.

In my dental hygiene career, I've seen thousands of examples of both excellent and poor-quality dentistry and cost is not typically a determining factor of the expertise or skill of the clinician. In fact, at one time, a great quantity of really bad dentistry examples came from what we called then "the Gold Cadillac" practices. (example, poorly constructed gold crowns so ill fitting they caused pocketing, bone loss and periodontal disease and often decay under 'overhangs' or bulky crowns). General Dentists who did their own root canals were another example of nightmares. This wasn't in one little town, but from a wide area over several suburbs that included both wealthy and average-income communities. Low cost dentistry can be excellent and expensive is not a guarantee that it’s precise or good.

The problem is that much of the time, it's not possible for a patient to assess the quality or accuracy of the procedure. Visually, all may look great, but it's the technique and actual 'fit' that determines quality. Additionally, if the 'bite' or occlusion isn't checked for functionality, many procedures can cause other problems with opposing teeth or jaw pain from occlusal discrepancies and often headaches or neck pain.

I've known some of the nicest people who are dentists, but their work is absolutely atrocious. Buyer beware. Get reliable referrals… I always recommend asking for referrals from a well-known and respected Periodontist as they typically see dentistry from across an entire community.

Jackie