Medical costs out of control?

[Traveler]

A while back I posted about our trip to Hawaii and my wife breaking her arm on a hike. It was a few hours before we could get to civilization and to the emergency room. We were at emergency about 45 minutes - of which 35 to 40 minutes were spent waiting. I am not complaining - we got okay service even though we spent most of the time waiting.

They took x-rays and put her arm in a cast - there was no need to set her broken bone. All the doctor did was look at the x-rays and tell the medical assistant to prepare the splint. Total time talking to a doctor was about 1 1/2 minutes. We did laugh and talk with the assistant for a while - but that is because we were waiting for the doctor to look at the x-rays. BTW the doctor was an intern.

The bill for all this was $1,500. It is difficult for me to believe that the actual cost of materials and time could not be done profitability for at best just over $100 or at worse 10% of what we were charged. Most of this will be paid by insurance but in reality insurance companies will not stay in business in less they charge enough to pay the bills.

When a middle class citizen with insurance sees a doctor it is obvious that the charges cover a lot more than just our personal costs. My research indicates that the greatest cost and the continuing increases in medical costs are because of 2 reasons.

#1. Malpractice insurance - In talking with my doctor I was informed that many doctors pay out $500,000 a year for malpractice insurance even though they have never had a single claim against them - ever. Especially OBGYN - hope I have that right - because of high risk during delivery and birth can pay even more.

#2 Increasing numbers receiving health care that pay nothing and contribute nothing. Especially at emergency receiving. This is because by law every person that shows up at emergency requesting help must be serviced - even if their need does not fall under emergency services.

My point is that if we are ever to have affordable health care in this country we must address and solve the out of control costs particularly concerning these two issues. Currently going into effect is what is called the Affordable Health Care Act. This new government health care does not address either of the two reasons I have listed as the primary reasons health care costs are out of control - therefore I do not believe this program or any other will ever help control costs and do anything towards making health care costs affordable.

The Traveler

Edited October 18, 2012 by Just_A_Guy
Removed passing reference to political candidate

[Smudge]

I am fortunate in that I live in the UK and we have nationalised health care - which while it does have its down sides is free. A few years while working at summer camp I injured my ankle and after being unsure whether I was putting through on workers comp or my insurance - I put it through workers comp - and that was turned down - I came home to a bill of nearly $1000 for an Xray, an Ice pack and an air cast. I found myself wishing I had just used my insurance and paid the $50 co-pay. But I looked at the bill and wondered how those things cost that much.

I think that there is a balancing act to getting health care to all who need it. As long as people need health care we are a captive market and people can charge what they like because they know that we have no choice but to pay (or not as the case maybe)

[Guest]

I agree, it's out of control. We don't have insurance. My husband has to suffer without a medication that would greatly help a condition he has because without insurance it would be $250 a month, plus doctor visits. So he makes do with the other one he's supposed to be on (that is "only" $80 a month). I've gone off a couple of mine as well, but thankfully have been able to control things with lifestyle changes. My kids have pretty bad environmental allergies and we're doing the best we can with over-the-counter meds. We could barely afford the treatments when we were insured; there's no way we can now.

I was in a car crash recently and just to get checked out, not even treated in any way, but a 10-minute once-over, was $400. Of course the insurance of the person at fault covered that, but I have to say that's pretty ridiculous.

[mnn727]

I have a somewhat life threatening medical issue, recently found and hospitalized for. I will be taking a medicine for quite some time that costs $7000 a month without insurance. Thankfully I do have insurance and its only $150 to me. I still haven't got the hospital bill (just got out 9 days ago) but I am way over my maximum deductible, it will be interesting to see how much it is.

Now for someone uninsured, how can they afford that medicine that is needed to keep them (me) alive. Biggest chances are without it I would be dead within a year, with it I should be able to live out my normal lifespan (God willing)

I would sure like a Canadian style single payer universal health care system. on other boards the Canadians all love it, the only people who don't like it are US Americans. What was passed by Congress and signed by the President is a joke, the only parties that benefit by it are the insurance companies.

Edited October 18, 2012 by mnn727

[Traveler]

I have a somewhat life threatening medical issue, recently found and hospitalized for. I will be taking a medicine for quite some time that costs $7000 a month without insurance. Thankfully I do have insurance and its only $150 to me. I still haven't got the hospital bill (just got out 9 days ago) but I am way over my maximum deductible, it will be interesting to see how much it is.

Now for someone uninsured, how can they afford that medicine that is needed to keep them (me) alive. Biggest chances are without it I would be dead within a year, with it I should be able to live out my normal lifespan (God willing)

I would sure like a Canadian style single payer universal health care system. on other boards the Canadians all love it, the only people who don't like it are US Americans. What was passed by Congress and signed by the President is a joke, the only parties that benefit by it are the insurance companies.

While doing some consulting work in Phoenix I met a USA doctor who had a practice just over the border in Mexico. He was ha heart surgeon and said that he can fly his patients in from NY perform open heart surgery provide a week stay in his (and other USA doctors) hospital for a week and fly the patient home for less than it would cost them for a year of insurance and make more $$$ than practicing in Mexico than in the USA. The reason his costs were so low – There are no un-paying patients and no malpractice.

I joked and asked about unqualified doctors – he laughed and said – one mistake and you are out of this business forever. In the USA if a doctor makes a mistake – the insurance pays and no one cares. And it appears that in order to open a practice a doctor has to be recommended by other doctors in the clinic. He told me that malpractice just is not a problem. Interesting.

Here is a thought – lets pass a law that says that anyone that receives free health care in the USA must forgo any malpractice reimbursement – thus the only reason to sue would be for criminal negligence to remove the doctor’s license. Not a total solution but a way to reduce costs.

The Traveler

[MarginOfError]

I, too, would like to see a single payer healthcare system like Canada's. This has a lot of advantages. In my opinion, the chief advantages are a) everyone is paying in, and b) a nationalized healthcare database.

That second one is an odd one, I'll admit, and probably not something people outside of my field would covet (some, in fact, would fear it). But with a nationalized healthcare database, we could build far better models for predicting the results of medical care. We have the ability now to do things with statistical models that could give physicians and patients personalized information about their care that could lead to better informed decisions and more appropriate care. (The key to this is, of course, making sure that people don't rely on the models to make the decision, but use the models to inform the decision--something that we struggle to get people to do).

The other thing that might help (and you'll think I'm crazy for saying this) would be to extend the length of patents on new drugs. The cost of developing the drugs is astronomical, and drug companies only have so long to recover those costs before generics can be produced. Giving them a longer period in which to recover those costs might bring the cost down, but probably only a very little.

The major thing we need to do (and this is imperative) is we need to improve the diet and exercise habits of Americans. In the vast majority of the studies I work on, the majority of patients would no longer need medication or treatment if they changed their lifestyle. We have to break the culture of "if we just pop some pills we can keep living the way we do.*"

* I recognize that there are people who are just sick. For whatever reason, their bodies don't function normally. But these people form a relatively small subset of the population that I would love for us to be able to focus on.

[classylady]

As of August, we are currently without health insurance. I'm just praying nothing happens. Both hubby and I are on prescription medications. I don't know when we'll next be able to buy our prescriptions, so, I've been cutting my medication in half, hoping half a dosage will be better than running out and not having any meds. I haven't been to a dentist in years. I've had an abscessed tooth for about 4 years. I've lost 5 teeth in the last couple of years. We simply haven't had the money for the dentist. Now that we don't have health insurance, I don't know what we're going to do. Both hubby and I are diabetic and need high cholesterol medication. Hubby also has asthma, sleep apnea, allergies, and high blood pressure. If I start to think about it, I start to panic. I try not to think about it.

[Smudge]

there are programs in place to help pay for meds for the uninsured. I know that for years my friend has got all her asthma and anxiety meds through these programs because she is uninsured (she was bare;y earning enough to pay for fuel to work let alone paying insurance). Initially it was programs that her Dr told her about directly through the drug companies but now it is one run through the local hospital

[pam]

As of August, we are currently without health insurance. I'm just praying nothing happens. Both hubby and I are on prescription medications. I don't know when we'll next be able to buy our prescriptions, so, I've been cutting my medication in half, hoping half a dosage will be better than running out and not having any meds. I haven't been to a dentist in years. I've had an abscessed tooth for about 4 years. I've lost 5 teeth in the last couple of years. We simply haven't had the money for the dentist. Now that we don't have health insurance, I don't know what we're going to do. Both hubby and I are diabetic and need high cholesterol medication. Hubby also has asthma, sleep apnea, allergies, and high blood pressure. If I start to think about it, I start to panic. I try not to think about it.

I can understand. At this point I don't have medications that I take regularly. However, if that should be the case in the future and they are costly then I'm going to panic. My health insurance plan only pays $500 a year max for prescriptions.

[Dravin]

The other thing that might help (and you'll think I'm crazy for saying this) would be to extend the length of patents on new drugs. The cost of developing the drugs is astronomical, and drug companies only have so long to recover those costs before generics can be produced. Giving them a longer period in which to recover those costs might bring the cost down, but probably only a very little.

What specifically do you see this helping cost wise for the consumer/patient. At the start of this paragraph you seem to be leading to an argument of extending the window to recoup costs. Basically Cost/Time could be made smaller (i.e. instead of charging $150 for a 30 pills they can charge $75 because they have twice as long to recoup costs*) because the time component would be larger, but you seem to harpoon such an idea with the last half dozen words in the paragraph. So is it the probably very little decrease that you think will help, or something else?

P.S. The debate on the consumer benefit of cheaper but longer termed brand named drugs versus more expensive shorter termed brand named drugs with sooner cheaper (cheaper is of course relative, not all generics make Walgreen's $4 a month list) generic has to be an interesting and complex one. Particularly if you start considering the impact on drug development either direction may have.

*I realize that accounting wise it wouldn't be anywhere near that simple as you can't count on the number of consumers remaining constant even if you remove generic versions of your own drug from the picture until costs are recouped (well plus some amount of profit, they are for profit ventures after all).

Edited October 19, 2012 by Dravin

[Backroads]

The BSA was revealing its new insurance offerings yesterday. Nothing terrible, but there was one option BSA was pushing like crazy... it would save them money, make us all miserable. I didn't really care as we will probably be switching over to the army's insurance plan. Right now my insurance is decent--paying $140 a month for the doctor's bill for the baby appointments.

I also think the Canadian system ain't a bad idea--what we USers just got is stupid. It seems it mainly a bunch of people complaining about insurance companies and then making the insurance companies responsible for everything.

[Traveler]

This particular post may sound cold and heartless but the reality is in the USA that the two biggest health problems are because of poor diet and lack of exercise but the two most common treatments for health problems are drugs and surgery.

The bottom line (pun intended) is that anyone that is overweight and not involved in a rigorous exercise program - is unnecessary contributing to out of control medical costs - both for themselves and for the society in which they live.

With very rare exception if someone needs medication and is also overweight and living a sedate life style - it is my personal concern that their spiritual commitments and covenants are misappropriated and poorly maintained. In short, they are as in need of repentance as someone that is also disobedient to the more generally understood and socially unacceptable taboos in the Word of Wisdom, prominent in LDS culture.

The Traveler

[MarginOfError]

What specifically do you see this helping cost wise for the consumer/patient. At the start of this paragraph you seem to be leading to an argument of extending the window to recoup costs. Basically Cost/Time could be made smaller (i.e. instead of charging $150 for a 30 pills they can charge $75 because they have twice as long to recoup costs*) because the time component would be larger, but you seem to harpoon such an idea with the last half dozen words in the paragraph. So is it the probably very little decrease that you think will help, or something else?

P.S. The debate on the consumer benefit of cheaper but longer termed brand named drugs versus more expensive shorter termed brand named drugs with sooner cheaper (cheaper is of course relative, not all generics make Walgreen's $4 a month list) generic has to be an interesting and complex one. Particularly if you start considering the impact on drug development either direction may have.

*I realize that accounting wise it wouldn't be anywhere near that simple as you can't count on the number of consumers remaining constant even if you remove generic versions of your own drug from the picture until costs are recouped (well plus some amount of profit, they are for profit ventures after all).

You're about right (if I'm understanding you). If they had longer to recoup their costs, you might see lower prices, but because of the wonder that capitalism is, I imagine you'd see $150 prescriptions drop closer to $120 instead of $75.

I think I was also leading into my point about lifestyle. The savings we could generate by prolonging patents would be small relative to the savings we could generate by living healthy.

[Dravin]

You're about right (if I'm understanding you). If they had longer to recoup their costs, you might see lower prices, but because of the wonder that capitalism is, I imagine you'd see $150 prescriptions drop closer to $120 instead of $75.

Okay, I think my confusion lay in I wasn't sure what your idea of very little decrease was.

[NeuroTypical]

Yeah, I do more than geek on a computer at work. I also geek on a computer at home. And I geekily use a budget tool to track our family's spending. Just for grins, I thought I'd see what our (real, un-made-up, unmassaged) health insurance spending over the last 4 years looks like. This is genuine unaltered LM family budget data.

[Traveler]

Yeah, I do more than geek on a computer at work. I also geek on a computer at home. And I geekily use a budget tool to track our family's spending. Just for grins, I thought I'd see what our (real, un-made-up, unmassaged) health insurance spending over the last 4 years looks like. This is genuine unaltered LM family budget data.

Just an additional point of reference. In 1974 when our first child was born very few people had medical insurance. The cost - we had insurance - was $300 and included 4 nights and three days in the hospital for my wife, all the doctor visits and the follow-up. Going to see a doctor cost less than our current co-payments. And health insurance - that was only for unusual things - like cancer, not for checkups and common things like stitches or broken bones.

The Traveler

[BadWolf]

I'm hearing some very scary, and quite frankly unchristian things... Just summing up;

1)- Poor people/uninsured do not deserve the same healthcare, nor legal rights as wealthy &/or insured people.

.... To add on: An uninsured family goes to the doctor. Their child's eye is superglued closed by the doctor on accident. Despite that it will cost them hundreds of thousands of dollars over many years, and despite that no insurance company will ever take their child for/because of this serious pre-existing condition, now... They shall have no legal right to seek recompense. Even though they will have no way to pay for ghe ocular surgeries needed, nor ongoing therapies, and their child will just have to learn to live blind, and too darn bad. (Actual case)

.... And if a poor person or their loved one dies due to medical malpractice, well, we're not even going to give you the 10k to bury them, MUCH LESS money for attorneys fees. Since you are unable to pay for insurance, you should really have a spare $250k laying around for the attorneys fees involved in a medical malpractice case, right?

((The argument : Well the hospital/clinic/doctor should pay for mistakes is WHY they have medical malpractice insurance to begin with. First guilt has to be proven (but poor people are now unable to do that, because no lawyer will take them). THEN the doctor has to pay, out of pocket... Ongoing care ALONE run into hundreds of thousands if not millions... Much less lost income/legal fees/pain & suffering/etc. which are all part of a compassionate/balanced/just system. It's a circular argument. In order to be ABLE to pay, they need malpractice insurance.))

2)- Fat people do not deserve the same healthcare, nor legal rights as thin people or people who can afford (financially & physically) to be in a rigorous exercise program.

... Doesn't matter if you're fat because you're poor (and cannot afford healthy food), or because you have an injury that precludes you from exercise (hey all you vets who've lost a limb, go climb a tree... Ditto former athletes who've been injured, firefighters and police & other physically demanding jobs... You get injured and can't workout and get fat: we don't care about you), a medical condition (noninjury, such as a heart condition, cystic fibrosis, certain cancers, the list here gets reeeeeally long), or you just had a baby, or you're genetically predisposed (regardless of health, endomorphs are often extremely healthy: Think Polynesian or Linebackers), or in grief (widows/widowers, parents of lost children, children who have lost parents, rape victims, etc.), taking medication that makes you fat (steroids for asthma, antidepressants, etc.), are recovering from an eating disorder (anorexics & bulimics tend to be 50lbs OVERweight for 5+ years once they start living healthy), or are single parents working 2-3 jobs, are kinship & or foster parents, are parents of children with severe medical issues that need round the clock care..... We plain and simply do not care about you. Because you're fat, you don't deserve the same treatment a thin person does.

3)- 40,000,000 people without health insurance should have NO access to healthcare, much less quality healthcare.

That's the more than the total combined populations of New York, Boston, Chicago, LA, Frisco, Seattle. As a visual image. ALL of those cities filled with millions of uninsured people. Every single occupant. The ER is the last ditch place where people can receive medicines and care necessary to live. And NOT ALL. The numbers of oncology patients dropped (and so they die of their treatable cancers) are wretched. The number of people who dies of the common cold and flu (50,000 on average in the US every year, mostly uninsured children & uninsured elderly... Which is a pretty key point, already the 2 most vulnerable populations for illness dying of a gosh darned COLD). Now the ONE hospital that MAY accept you in the ER (private hospitals can and do turn people away, as they are NOT required to take you, even if you're bleeding out... The only hospital required to take every patient are 'County' hospitals)... Sorry. We'd rather have you die than create more overhead for hospitals to pass on.

____________

I come from a family of doctors & nurses & researchers. I've worked in healthcare for years. YES there are some massive problems with the system: But denying care to people, trying to say who 'deserves' healthcare, is NOT the solution.

[Vort]

2)- Fat people do not deserve the same healthcare, nor legal rights as thin people or people who can afford (financially & physically) to be in a rigorous exercise program.

... Doesn't matter if you're fat because you're poor (and cannot afford healthy food)

Not responding to your overall point or anything else than this specific assertion quoted above.

I have heard this assertion many times, and it makes no sense to me at all. From what I can see, healthy food costs significantly LESS than fattening processed foods.

Poor people tend to be obese, but in my judgment, it is not because they "can't afford" healthy food. Here is my analysis:

I see two obvious contributors to "poor obesity".

• It is a cultural problem; the culture of most poor people is such that it tends to make them obese. There seems to be no particular aversion to obesity, and physical activity is not a priority, either for work or for pleasure.
• It is ignorance; many or most poor people simply do not know how to eat well. Cheetos, pork rinds, and beer seems perfectly natural as primary foods. And in many cases, such people have never been taught how to prepare food beyond opening the cereal box and unscrewing the milk cap.

The attitude of many poor people is "get it NOW, while you can!" (see point 1). Coupled with other societal factors, their ignorance of how to eat well and exercise, and the lack of immediate and obvious payoff for adopting a healthier lifestyle (societal problem again: delayed gratification is not a priority in poverty cultures, and in fact is usually not even on the radar), obesity is the almost inescapable result.

[Guest]

/Junk food is expensive because it is nutritionally anemic.

But I have to say, since I've switched to a diet of vegetables, more protein (I'm not talking steak, I'm talking chicken thighs, ground beef, etc.), and whole grains, I'm spending a whole lot more on food than when I was making more pasta, pancakes, etc.

It's not as simple as Cheetos and beer.

[classylady]

/Junk food is expensive because it is nutritionally anemic.

But I have to say, since I've switched to a diet of vegetables, more protein (I'm not talking steak, I'm talking chicken thighs, ground beef, etc.), and whole grains, I'm spending a whole lot more on food than when I was making more pasta, pancakes, etc.

It's not as simple as Cheetos and beer.

Or as cheap as Ramen noodle soup or a box of mac & cheese.

[annewandering]

Wow. Poor people are fat because they are stupid and they cant be bothered to learn to eat better than their fat culture?

Way to insult and perpetuate stereotypes.

[Vort]

Wow. Poor people are fat because they are stupid and they cant be bothered to learn to eat better than their fat culture?

Funny, I didn't say anything even approaching that.

Way to insult and perpetuate stereotypes.

Way to lie shamelessly and make yourself look like a fool.

EDIT: anne, you're good at imagining non-existent meanings and then condemning people for words they never spoke. Let's see your brilliance further on display as you provide YOUR analysis of why the American poor are so disproportionately obese. Is it because decent, nutritious food is just too expensive? Or maybe all poor people suffer from a rare glandular disorder?

Edited October 19, 2012 by Vort

[Traveler]

One of my wife's favorite TV shows is called the Biggest Looser. It is a reality show concerning obese individuals trying to lose weight. It is interesting to me that most of the overweight individuals also have terrible financial habits. But is seems that the worse of problems these individuals face is the proclivity to blame everything else for their situation. On the show the greatest problem is getting individuals to take responsibility.

I understand that there are some people who are severally limited in their physical and mental capabilities such that they cannot take care of themselves and require someone else to care for them and make decisions for them. This is different that someone that needs temporary assistance to get through difficult times.

However, for LDS, with access to our welfare assistance - I really do not see any excuse at all for anyone to eat unhealthy foods. If they cannot afford proper food - there is means and help.

As a consulting engineer I often come to an impasse with clients unwilling to pay for needed improvements outside of our contract. I ask the question - How important it is for this company to improve their operations. In other words - why are you asking for these improvements - do you think they are worth your while to implement them? When they say yes - it is important to them. Then I say - okay let’s talk about a dollar amount - how many dollars is it worth to you? This often catches them off guard and they say that they are paying me plenty and that I should provide it. I then point out that they are only paying me for what we contracted - but I am willing to consider perusing this issue if we can come to an understanding of how important this additional effort is worth to them.

I then point out - that it is very important to me to improve their capabilities to compete in the market place with their products and services. But I tell them that if this addition really is not important enough to them to consider even discussing their contribution to achieve it - that in all honesty it is not any more important to me.

This, I believe to be true when performing services and assistance to those needing assistance. I do not mind making a contribution - but I see no logic or morality in providing for someone what they are capable of providing for themselves but unwilling to do so.

In truth we all need a hand and all should be willing to contribute whatever we can. Anyone can be wealthy - all that is required is honest work and the discipline to spend less than you earn. Those that think being wealthy means you do not have to work as hard or be careful with you money - will not be wealthy for very long.

As long as there are elements in our society that believe they should not be responsible - there will never be a means to provide affordible health care.

The Traveler

Edited October 20, 2012 by Traveler

[Guest]

I conducted an impromptu experiment just now. I'm in a room of 32 people. I'm the only one who knows how to raise, kill, remove the feathers and cut up chicken in this room. All of them thinks they can figure it out if they need to, but none of them actually learned how to do that. They can all cook chicken.

If we can raise and eat our own chicken, we'll be a lot healthier. It's illegal to do that where I live.

All of 31 of them say they have been on some over-the-counter or prescriptiom medication this year (cough syrup being the mst common). I'm the only one who has not had any meds this year. If we allow our bodies to heal itself naturally, we'll be a lot healthier. But then, I have the luxury of being able to work while sick (work at home).

Healthcare is a very complicated problem caused by a complex cause-and-effect, cure-leads-to-more-illness cycle.

[MorningStar]

I believe health care is expensive for many reasons, including advances in technology.

When I broke my foot years ago, it just wouldn't heal on it's own. There wasn't a lot of circulation to the area, so after 12 weeks of no healing, they finally got me a "bone stimulator". It's a mini ultrasound machine and it costs $4,000. I had to pay $400. The FDA ruled that it can only be used by one patient for one event, so it's battery powered and if you need to use it longer, you mail it back and they will recharge it for you, then send it back to you.

I can't think of any logical reason why they decided this, but the manufacturer told me I could mail it back to them to recycle it and they would be able to fix it up and use it for another patient. I asked, "Do I get any money back for that?" "No." "And you still get to make another $4,000 off of it?" "Yes." I told them, "This is about to be the most expensive toy my children have ever owned."

I'm sure this is just the tip of the iceberg when it comes to ridiculous policies.