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the price of healthcare
Obamacare Is Still Failing
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  • ——————————

    A few years ago I had 4 stitches put in my finger at the emergency room of a local hospital. It was done by a nurse (I never saw a doctor), and I was in and out in a little more than an hour; just under $2000…and that didn’t include the Tetanus shot they tried to force on me, which I refused because I was cut with my kitchen knife that is washed several times a day.
    In the same year my wife was in the most prestigious hospital in her country for 12 days in a private room for medical procedures, was attended to by European trained doctors, and the total bill came to about $30 less than my 4 stitches…so yeah, medical care is too high here.

    Of course I think doctors and nurses need all the schooling they are required to have, but I wonder how much the cost of academia figures in to the cost of medical care?….

    • Ofer Imanuel

      You are quite right on a lot of things. But I do not think that requiring an MD to get a BA before he can start studying medicine makes sense. BTW, in some developed countries, it is not a requirement.

      • ——————————

        Now that’s a good point!

        As an alternative, the requirements could be more residency (at least docs would get a bit of payment and save on school expenses, while actually honing their skills in the field), or more med schooling (expenses for schooling would be spent on learning that is actually important)…or a combination of both.

        You are right that 4 years of reading ‘riting, and ‘rithmatic for many medical professions is a waste of time and money….

      • Boritz

        In mid-twentieth century America a bachelor’s degree was recommended but was not required for admission to medical school. That requirement was added later and with 30 qualified applicants for every open position it’s hard to see how an applicant can be competitive now without joining the crowd.

        • Ofer Imanuel

          Change medical school (and law school) to take undergrads? Add more schools? For both of these, the QC is with the bar exam.

          • Fat_Man

            Law school should be a two year program for a certificate at community college. Physicians actually have a fairly large body of knowledge to master. There are probably about four years worth of classroom science that they need, which is what they get in their undergraduate courses and the first two years of med school. After that they need three years in the clinics, which is what they get in med school and internship.

      • Fat_Man

        The system choke point is the number of residency slots, which is determined by Federal Government. It is about 25,000 per year. The result is that the US has fewer doctors per-capita (2.6/100,000) than most other industrialized countries. Germany has more than 4/100,000, and the OECD average is 3.3

        • ——————————

          What is your opinion on why the feds limit the entry slots to that amount? Why would they not want more docs in the field?

          Maybe there is something I don’t know, but it seems pretty asinine to me….

          • Fat_Man

            AMA.

          • ——————————

            Aahhh…artificially supported earnings…got it!

        • C T

          And yet look at the number of lawyers we have. Around 1/300.
          Do you know why they tried to get the original poster to accept a tetanus shot? To protect themselves from a negligence lawsuit down the road. EVERYONE in medicine is practicing defensive medicine in order to protect themselves from malpractice lawsuits, and that runs up costs very quickly. Innovation is dying in the face of malpractice-proof protocols, and costs are soaring. When will it end?

          • Fat_Man

            Too many lawyers not enough doctors. What a mess.

    • Fat_Man

      Only in so far as it impels Doctors to go into the most highly paid specialties in order to pay off student loans, which can be upwards of $400,000.

      When the Federal Government imposes wage and price controls on the health care industry, they will have to trade a deal on these debts for the salary caps they will impose.

    • Fat_Man

      BTW: Did the final EOB from your insurance company reflect a $2,000 payment? or was it a lot less? It usually is.

      The $2,000 is often the opening bid based on the hospital’s charge master. It is very seldom the amount they are paid.

      • ——————————

        I didn’t use insurance. I am self-employed, so I have high deductible to keep rates down….5K I believe. Except for a few small nicks and dings like this along the way, I haven’t needed anything medical for over 35 years, so it’s cheaper to keep the high deductible.
        The worse part is that it happened on a Sunday evening after the local clinic was closed. The clinic would have done the stitches for $85!
        I didn’t know what the hospital charges would be until I got the bill a few weeks later. They don’t tell you/or know the charges, when you are there.

        • Fat_Man

          Before I was on Medicare, I had a $10K deductible. I still submitted all of my claims and the hospitals did write down the bill in accordance with their contract with the insurance company. That was a major reason why I kept the policy.

          • ——————————

            The hospital gave a 20% discount for paying within 30 days, so I did get a discount.

            I didn’t realize I could do that what you did. I never use my insurance so I should probably spend a bit of time learning it better for when i do use it….

    • RedWell

      That cost is marginal relative to the fact that hospitals are (1) opaque in terms of pricing and (2) virtual monopolies.

    • C T

      You went to the ER for a 4-stitch cut? Was the urgent care closed?

      • ——————————

        Yeah, it was a Sunday evening, so the local clinic was closed.
        They would have done it for $85.

        The cut was on the inside of finger at the knuckle. I wasn’t sure if tendons were damaged, plus being at a joint it would be hard to close by itself.
        i would have spent the 2K even if they told me the price upfront. It’s not worth possibly losing dexterity over trying to save 2K.

  • Andrew Allison

    You continue to ignore the elephant in the room, namely insurance. Here’s a thought experiment: the major private health insurers claim to have lost around $1B apiece on the exchanges and yet are still highly profitable. Employer provided health insurance is not merely taxpayer subsidized, but drives up the cost of care by hiding the cost of care from participants.

    • SDN

      And how much of that is making sure they have all the records needed to defend against lawsuits those other countries won’t allow? Reform the tort system Democrat donors love.

      • Andrew Allison

        None of it. The costs to which I refered are, as I wote, adminstration and tax subsidies. I agree that the trial bar is an abomination, but it’s the care providers not the insurance companies who are the victims.

    • Amardoc12

      Fallacious reasoning from the outset, with the extreme leftist penchant for characterizing employer-paid health insurance benefits as “the government spends $250 billion a year on tax credits for employer-based coverage” demonstrating the inherent leftist bias that people and companies being “allowed” to keep more of their earnings is somehow an unfair taking of money from an unbelievably bloated federal leviathan. It was never the government’s money in the first place.

      Defensive medicine adds costs as has been mentioned, and the government-imposed necessity for an ever-growing bureaucratic force to comply with increasing government regulations on medical practice adds to the cost of health care without adding any actual medical care. The other dirty little secret that leftists never ever want to acknowledge is that because of government price controls/rationing imposed on Medicare/Medicaid, private insurance has to pay higher costs to make up for the losses hospitals and doctors/practitioners are forced to eat taking on CMS-covered patients. An ever growing number of private practice physicians refuse to take Medicaid and Obamacare patients because they cannot be paid what it costs to have such patients come into their clinics.

      As far as supply of doctors is concerned, there are plenty of residency programs that have trouble every year filling their available slots. One report a couple of years ago stated that by 2030 the US is likely to have a physician shortage of 90,000 in primary care specialties. That is not likely to improve with talk of further government regulation, socialist takeover of the medical system, and lowering of physician compensation.

      • Andrew Allison

        You are confused. First, the $250 billion is foregone tax revenue which hides the true cost of empolyer plans. It is, to use your terminology, a “taking” by employers of tax revenue which must be replaced by all taxpayers. Second, of course, defensive medicine adds cost to costs, but the $1 billion of so in administrative overhead is on top of what the companies pay for care.
        I agree with you that there’s a problem with Medicaid (inadequate reimbursement), but that has nothing to do with the subject of my comment, which was insurance. You may be right that providers are charging private insurance companies to compensate for medicare reimbursements, but I suspect that it has much more to do with the cost of processing claims. I’ve seen reports that 25% of the typical primary care revenue goes to insurance overhead (to the point that more and more care providers are offering significant discounts for payment in full at the time of service delivery). It would be interesting to see how the reimbursement actually paid by private insurers comares with Medicare reimbursement.

  • FriendlyGoat

    From snake oil to sanitation to preventable errors, sooner or later we will learn that “medicine” does not regulate itself either in efficacy or financial matters. The more the CITIZENS make the rules, the better it works—–period. Government is how that is done, because markets alone can’t. How do we know? Well, we’re in a major mess, aren’t we, from decades of pretending that free enterprise should mostly be running the show?

    • FluffyFooFoo

      What? The free market has been limiting the immigration of doctors how?

      • FriendlyGoat

        You do know that a country like the United States which somehow needs to import physicians has gone bonkers, right?

        • FluffyFooFoo

          In aggregate we are definitely bonkers, but the free market isn’t why there aren’t more doctors in the US.

          • FriendlyGoat

            You’re getting close to suggesting that no foreign-grown doctors in their right minds should want to come here to practice, you know.

    • seattleoutcast

      Citizens make the rules by having a choice in how they spend their money. They get this choice when there are a larger number of business that compete for their money. They get a larger number of businesses when there are fewer regulations, because fewer regulations means the bar is lowered for smaller, nimbler business to enter the marketplace.

      Regulations, which stifle the number of businesses, are often put in place by the larger corporations who have the money to hire lobbyists.

      Remember when there were more than three tire companies? No, you don’t. Before FDR’s price controls that would “help the common man” there were many companies. After price fixing…er, price regulation, the number dwindled to three. This means that citizens were not allowed to make the rules.

      • FriendlyGoat

        Fine. You go shopping for health care at retail all you want, okay? I got introduced to this as one of the administrators of a group plan for several hundred people in the early seventies and continued with that for 20 years. That was 45 years ago. Talk to any employer and they will tell you that cost control has been a problem the whole time since, okay? America does not HAVE to be paying double. We really don’t HAVE to. We structurally build in ridiculous pricing and coverage schemes and then wonder why it costs so much. Half a century should have been long enough figure this out. Most other nations did.

  • Ann in L.A.

    Bottom line: According to the DHS, the US spends over $10,300 per person per year on heath care. That comes to over $20,000 per worker.

    Now…how do we pay for that?

  • Jim__L

    One simple point — expand the number of seats at American medical schools. Why import them when we can train our own?

    • Ofer Imanuel

      Market force of competition? Medical school here is ridiculously expensive, and makes doctor obligated to take their tuition out of our hides.

      • Jim__L

        All the more reason to expand supply.

        • Ofer Imanuel

          No argument here. But importing as well as training more is even better. Especially as the importees provide competition who do not owe a fortune for their tuition.

      • Fat_Man

        That is determined by the Federal Government in collusion with the Med Schools and the AMA. A lot of the first two years of med school is lectures — profs reading power points in dark rooms. It could be recorded and put online.

  • Fat_Man

    I think Aetna may have handed the GOP a sales point in pushing their bill.

  • John Dowd

    One way to keep “costs” down is too stop importing poor people from third world countries (Mexico) and treat them at public expense. Illegal aliens get free care via the Emergency Room at the expense of everybody else. If ICE is allowed to do its job they will get treated in their native country instead of our country. Like Trump’s Wall Mexico should pay for the medical bills of any of its citizens that get care in this country. That would also apply to any other country and to be “fair” it would apply to the United States. If Mexico balks then the US government should determine the total cost of Mexican deadbeats and recover it through a special tariff.

  • Jacksonian_Libertarian

    Free Markets are the “only way” to get continuous improvements in Quality, Service, and Price. The Healthcare industry is an awful mix of Third Party payers (Medicare/Medicaid, VA, and Employer Paid), and now Obamacare subsidies, and mandatory purchase of unneeded coverage. To get any improvements in the Healthcare industry, at the very least, it must be made illegal for Employers to pay for Employees Health Insurance. Employers can still make carrying Health Insurance a requirement of employment, but each Employee must shop for and purchase their own.

  • solstice

    The main culprit behind astronomical American health care costs is the atrocious American lifestyle. Go to any public location in this country and you are guaranteed to encounter a significant percentage of people who are either overweight, obese, or numbed out by psychotropic drugs (in both their legal and illegal varieties). This is because so many American lead sedentary lives, ingest large amounts of low quality food, spend countless hours at schools and jobs that bore them to death, and spend still more hours consuming mindless, degenerate entertainment on television and the Internet. This is the perfect recipe for the explosion of psychological and health problems that we are currently experiencing and witnessing. Health care costs would go down dramatically if more Americans would just get off their butts and get out and about moving their bodies.

  • Forbes

    Since the last new medical school was opened, the US added 50+ law schools. A lawyer glut and doctors set their own terms. Supply and demand is real.

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