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  #46  
Old 11-19-2017, 12:01 PM
KevWind KevWind is offline
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If you spend more than you take in, profit based or otherwise, they work exactly the same. Costs have to go up, services have to go down, or you have to cease operations. Even in Gov't paid for services, you sooner or later will run out of other people's money.
Ah OK, but I think Sillies point or question was more about it being a "Business" at all and not about the HMO going out of business per se
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  #47  
Old 11-19-2017, 01:20 PM
Twelvefret Twelvefret is offline
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My post with graph shows 10 possible ones for starters.
Does not answer the question.
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IMO not the right right questions. And Medicine can be split into two parts, the quality and the cost. We (US) have the ability to provide as good or better care than any country in the world. There is no reason to believe that we can not also do so at a much more reasonable cost ratio ( unless you are willing to believe that we cannot do what other countries are able to do) . The question is why don't we do it. The answer is relatively simple and arguably has a significant amount to do with systemic entrenched profiteering coupled with successful disinformation .
I disagree. Medicine is a service which either is trying to cure, maintain, or keep comfortable.

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Personal example: my atorvastatin script. Cost $180 for 90 at the local King Supper or Walgreens
I get it online from from a US pharmacy (same exact drug mfg) for $23 pretty absurd don't ya think?
I have no way of validating. Express Scripts and Medi Scripts are aligned with insurance providers and as such provide a lower cost in three month increments. I don't know if that's what you are trying to say.

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I was talking specifically about costs being absurd, not services or products.
Ahummm ! "consider the OP when you make your responce " the OP did get an operation they got two night stay for 30K YES absurd totally absurd. Personally I would not spend 1k for a Martin juss kiddin' sorta .
We don't have a detailed account of the services the OP's wife received. We don't know anything other than his opinion he got overcharged. It would be premature to decide the charges are absurd.

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Could not agree more, but has nothing to do with finding much much more reasonable cost associated with access to it.
If you want to save on medical costs then choose to live healthy early in life. This does not apply to everyone, but it does apply to most.
  #48  
Old 11-19-2017, 01:50 PM
KevWind KevWind is offline
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Does not answer the question.
Of course it does. 10 countries have figured out how to provide care that rates better on overall quality and less cost. Maybe we should look at what and how they do it. The fact that you refuse to acknowledge the obvious and objective truth in the facts, does not diminish them

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I disagree. Medicine is a service which either is trying to cure, maintain, or keep comfortable.
OK you disagree. Irrelevant anyway, however you want to define "medicine" in the US ... it is overly expensive plain and simple .


Quote:
I have no way of validating. Express Scripts and Medi Scripts are aligned with insurance providers and as such provide a lower cost in three month increments. I don't know if that's what you are trying to say.
Opps I left out $23 for 90. there ya go validated. So no I was saying it's totally absurd there is $157 dollar difference for exact same meds and amount. And is a great example of the problems.

Quote:
We don't have a detailed account of the services the OP's wife received. We don't know anything other than his opinion he got overcharged. It would be premature to decide the charges are absurd.
We don't need a detailed account, he indicated they kept her for observation and then ran enough tests to drive the bill to 32k it's still absurd


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If you want to save on medical costs then choose to live healthy early in life. This does not apply to everyone, but it does apply to most.
Pretty obvious ( better health means less medical costs , not really news) and unfortunately used as a tedious cliche', solves nothing
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Last edited by KevWind; 11-19-2017 at 02:34 PM.
  #49  
Old 11-19-2017, 01:52 PM
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This is just plan not true, though it's been repeated so often by the lobbyists for medical administrators, medical device manufacturers, pharmacies, and medical insurance providers pushing for "tort reform" that many people assume it's based on facts.

The "hourly accident lawyer commercials" have nothing to do with it. The accident lawyers ("in a wreck? Call today!") advertising on TV and billboards typically only work car wreck case (and in many cases they don't even file lawsuits - if they don't get a quick settlement with an auto insurance company, they pass the case off to someone else). They have nothing to do with medical malpractice lawsuits, med mal insurance, or health care costs.

Finally, juries tend to have more sense than most people like to think. Those enormous verdicts people like to talk about generally happen in cases where plaintiffs actually need enormous sums to pay for the care they're going to need for the rest of their lives as a result of horrific injuries caused by someone screwing up.
Well, I think if you work in the medical industry (or know those who do) you wil have seen staggering malpractice insurance rates.

Sorry, but no one will need 20 million dollars for care and any exorbitant costs they suffer are a product of the very system that awarded them that amount.
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  #50  
Old 11-19-2017, 02:15 PM
Napman41 Napman41 is offline
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You are all missing the point. Why would anyone call for an ambulance or the EMT squad for nausea ? How about a handful of Tums, Imodium Ad or GasX ?
  #51  
Old 11-19-2017, 02:30 PM
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The only flaw that I can see in this is that you failed to negotiate before the procedure .
Not everyone has the ability to negotiate or be an advocate up front.

A close friend was skiing, was hit by an out of control skier, cited by the ski patrol, however he received severe injuries and was knocked unconscious. He was taken to the hospital and remained in a coma for several days with brain swelling, procedures and surgeries. He had no family to make decisions for him and was hit with a bill for over $250K. He sued the out of control skier, who was a 20 something with no assets and no real job and won a judgement however has never collected. My friend was young, self employed and had no health insurance coverage. The hospital sued my friend and won a judgement against his wages to pay the bill.

Beyond that, as others have said, in an emergency, you are relying on professionals to make the best medical decision not a decision based on quotas and cost. When your loved one has a heart attack, a stroke, or collapse and is rushed to the hospital. Time is of the essence. I would seriously doubt if any of us collapsed and were having a heart attack or stroke or any other emergency where our life was in the balance we would be negotiating the cost as the doctors administered their treatment on us.
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  #52  
Old 11-19-2017, 02:38 PM
Twelvefret Twelvefret is offline
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[QUOTE=KevWind;5541896]
Quote:
Of course it does. 10 countries have figured out how to provide care that rates better on overall quality and less cost. Maybe we should look at what and how they do it. The fact that you refuse to acknowledge the obvious and objective truth in the facts, does not diminish them
You wrote, "Except of course the question is specious because it presumes that the only alternative to absurdly expensive medical treatment is no treatment and Civil War era pharma.... And ignores the vast area of totally viable alternatives in between. " This implied there were alternative treatments, not alternative systems.
Quote:
Originally Posted by KevWind View Post
[

OK you disagree. Irrelevant anyway, however you want to define "medicine" in the US ... it is overly expensive, and unfortunately the "new plan" will make it worse not better .
No matter where you live medicine is the same. It either cures, manages, or keeps you comfortable until you die.



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Originally Posted by KevWind View Post
Opps I left out $23 for 90. there ya go validated. So no I was saying it's totally absurd there is $157 dollar difference for exact same meds and amount. And is a great example of the problems.
It does not matter what the charge is because insurance is contracted for an amount. Most plans cover a three month prescription. I am not saying you didn't have the experience, but I do not think it's common.
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Originally Posted by KevWind View Post
[
We don't need a detailed account, he indicated they kept her for observation and then ran enough tests to drive the bill to 32k it's still absurd
No, you can decide it was absurd without knowing the whole story.

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Originally Posted by KevWind View Post
[
Pretty obvious ( better health means less medical costs , not really news) and unfortunately used as a tedious cliche', solves nothing
Better healthcare means better treatment and disease management. It means you and you provider are on the same page. It means you take responsibility for yourself and those under your roof. It means you eat and exercise. If you do those things you will on average need to spend less.

Last edited by Kerbie; 11-19-2017 at 02:41 PM. Reason: Edited
  #53  
Old 11-19-2017, 03:13 PM
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Sorry, but no one will need 20 million dollars for care and any exorbitant costs they suffer are a product of the very system that awarded them that amount.
Really? When a young person becomes paralyzed and will need around-the-clock care with everything from eating to defecating for the next 40-60 years, how much do you think that will cost? You'd be into the millions of dollars even if you could get someone to do it for minimum wage, which isn't going to happen.

That's without getting into medications, medical equipment, and loss of earnings that his or her family might have depended on to survive.

Last edited by cmd612; 11-19-2017 at 03:28 PM. Reason: typo
  #54  
Old 11-19-2017, 03:21 PM
KevWind KevWind is offline
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[QUOTE]
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Originally Posted by Twelvefret View Post

You wrote, "Except of course the question is specious because it presumes that the only alternative to absurdly expensive medical treatment is no treatment and Civil War era pharma.... And ignores the vast area of totally viable alternatives in between. " This implied there were alternative treatments, not alternative systems.
Semantics, the OP and the discussion were about the "excessive cost" factor which is a product of the system, supplying the 'treatment" and what my post was about

Quote:
No matter where you live medicine is the same. It either cures, manages, or keeps you comfortable until you die.
Still not relevant to differences in the costs




Quote:
It does not matter what the charge is because insurance is contracted for an amount. Most plans cover a three month prescription. I am not saying you didn't have the experience, but I do not think it's common.
Of course it matters but you misunderstand. In this case there is no insurance involved
I don't have drug coverage it was just $180 at the local pharmacy or $23 on line.
And what does matter is that it is still very problematic because even if it is covered by insurance, then the insurance company is paying the absurd total difference or more likely a contracted discounted price but no doubt still some excess difference in amount (which it passes on thru to in premiums) . This cost differential is indicative of systemic problems

Quote:
No, you can decide it was absurd without knowing the whole story.
OK you win , I did exactly that

Quote:
Better healthcare means better treatment and disease management. It means you and you provider are on the same page. It means you take responsibility for yourself and those under your roof. It means you eat and exercise. If you do those things you will on average need to spend less.
I think most or all would agree that better choices , diet and exercise (and preventative care), will help reduce costs in the long run I know I do.
But that really does little to mitigate the current situation..... You taking responsibility for you and yours, does not really move us towards fixing the current problems . But as per the graph I posted there are steps that other countries have taken and could be analyzed and used to fashion hybrid steps that could fairly quickly start to move us in a less costly direction. But It would take some major rethinking of current policy and strategy and would be pitted against some very powerful profit oriented forces ., can't go any further except to say we probably have some fundamental differences in terms of perspective on private and public health care
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Last edited by KevWind; 11-19-2017 at 04:29 PM.
  #55  
Old 11-19-2017, 03:50 PM
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There is one gigantic historical foundation that most people are not aware of.

Comparing US costs is not helpful without this background information.


A long time ago, victims of accidents had to hire and pay a lawyer to represent them. Lawyers could not divert from their stable income-earning efforts to take on risky cases. Conversely, rich people could afford massive legal teams and often out-spend their opponents.

The result was that poor victims were not represented properly against liabilities and rich victims always were. There was a massive unfairness to the victims. If you hit a poor pedestrian on the street, don't worry they can't afford a lawyer.

So, the USA enacted regulations that allowed lawyers to keep 1/3rd of any liability judgement. The idea was to incentivize lawyers to take on those clients who couldn't otherwise pay.

This system was massively abused by greed and this is the reason you see hourly accident lawyer commercials. You can track on a graph the gigantic spike in liability settlements to when this occurred. This is what directly led to gigantic lawsuits. Lawyers had massive incentives to push for absurdly large judgments.

So,......this abused system resulted in gigantic lawsuits which, in turn, led to massive insurance and malpractice costs.

This, is what drove the USA healthcare costs to be the worst ratio of quality-to-cost in the developed world.

And you will never change this situation until you "undo" or reign in what caused it.

We have the most amazing doctors and scientists and provide fantastic healthcare. But the cost is driven by the lawyers and accountants.
The husband of a couple who we get together with on a regularly basis debunked this story. He is the hospital's Director, a 400 bed facility, and explained the costs which insurance carrying individuals pay are supporting those who arrive in the ER and have no insurance and no way to pay (who by law they must treat), and those on Medicare and Medicaid who's reimbursement to the hospital & doctors for procedures does not cover the out of pocket cost for the hospital or doctor.

He always says the amount billed to insurance companies for those with insurance or individuals with the financial means to pay out of pocket are carrying/paying for those unable to pay, and those on medicare and medicated. He said until the mandate for individuals to have insurance was a start to fix a broken system.

He said the mandate to have mandatory health insurance was good start as it assured the hospital would be reimbursed and thus held down the cost they passed along to insurance and cash paying patients. Given his background and experience his comments seemed very reasonable.
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  #56  
Old 11-19-2017, 04:11 PM
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...debunked this story.....
Thanks for that perspective. It certainly seems reasonable.
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  #57  
Old 11-19-2017, 04:15 PM
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An overseas medical event and then back home.

In 2011, while visiting my better half's family and friends in Taiwan, I collapsed and lost consciousness due a hernia. I was taken to the hospital by ambulance. It was quite serious per the doctors in Taiwan and I needed surgery ASAP. I had surgery, spent 5 days in the hospital and paid cash upon being released. The total bill was under $2,400. The hospital was very modern and approximately 10 years old.

My itemized bill included X-rays for $19 and a CAT scan with contrast for $325. My surgeon in Taiwan was schooled in the U.S. and graduated from an Ivy League school. The anesthesiologist was schooled in Pais. The nurses, and there were quite a few, would check on me every 15 minutes or so. My insurer re-imbursed me the entire amount.

I returned home and had another medical event (unrelated) within two weeks which required a CAT scan with contrast and as I entered the machine I noticed the machine name, Siemens, was the same as the one in the hospital in Taiwan. My statement from my insurer showed the hospital billed them $5,800. I could not help think back to my itemized bill from the hospital in Taiwan where the same CAT scan cost me $325.

In going over the U.S. CAT results with my doctor of 20 years, he commented that my rush to the ER in an ambulance and subsequent surgery in Taiwan would have run between $35K to $50K in the U.S. and I probably would have been done as an outpatient or spent no more than one nite in the hospital. It is baffling to comprehend the cost differences.
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  #58  
Old 11-19-2017, 04:34 PM
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Not everyone has the ability to negotiate or be an advocate up front.

A close friend was skiing, was hit by an out of control skier, cited by the ski patrol, however he received severe injuries and was knocked unconscious. He was taken to the hospital and remained in a coma for several days with brain swelling, procedures and surgeries. He had no family to make decisions for him and was hit with a bill for over $250K. He sued the out of control skier, who was a 20 something with no assets and no real job and won a judgement however has never collected. My friend was young, self employed and had no health insurance coverage. The hospital sued my friend and won a judgement against his wages to pay the bill.

Beyond that, as others have said, in an emergency, you are relying on professionals to make the best medical decision not a decision based on quotas and cost. When your loved one has a heart attack, a stroke, or collapse and is rushed to the hospital. Time is of the essence. I would seriously doubt if any of us collapsed and were having a heart attack or stroke or any other emergency where our life was in the balance we would be negotiating the cost as the doctors administered their treatment on us.
Life is not without risk and your friend was willingly engaging in a risky activity .
The scenario that you just related is an outlier and an anomaly .
I have no doubt that most of us were 20 somethings that lacked assets at some point . Unless this incident was intentional , I see no reason to attack the other skier .
I am curious as to the nature of " out of control " . A beginner tends to be out of control . Need more info .
Oh yeah , I am personally very familiar with risky activities and what can happen . I road raced motorcycles for a number of years .
As far as your loved one/s are concerned , this is exactly when you should step up to help them because they cannot help themselves and they can have established a durable or medical power of attorney exactly for this purpose .
  #59  
Old 11-19-2017, 04:37 PM
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  #60  
Old 11-19-2017, 05:13 PM
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Life is not without risk and your friend was willingly engaging in a risky activity .
The scenario that you just related is an outlier and an anomaly .
I have no doubt that most of us were 20 somethings that lacked assets at some point . Unless this incident was intentional , I see no reason to attack the other skier .
I am curious as to the nature of " out of control " . A beginner tends to be out of control . Need more info .
I should have used the exact term of the Ski Patrol, as I was told by Greg, my friend. The individual was "reckless" per the patrol and had been previously cited for reckless behavior on the mountain (which he learned as part of process in suing the 20 something). This individual was not a beginner, this occurred on the mountain where two trails meet up and Greg was stopped by the edge of the trail. Greg, who is a expert skier had just come down a double black.

This individual was considered "reckless" as he could not control his speed and stop, he entered the trail from an area marked "out of bounds" where he should not have been skiing. Fortunately, for Greg, the ski patrol, was right there when it happened. He suffered broken ribs, a punctured lung and a severe head injury and concussion. None of us knew about for a week or so as he was unconscious. I remember getting the call when he came out of the coma. His injuries were so severe he was airlifted to the regional medical facility.

Negotiating?
My former employer offered a CDHP plan about a eight years ago. CDHP stood for Consumer Driver Health Plan and I signed up for it. When I tried to negotiate the fees with the hospital for a procedure, I was told I could not. (I was responsible for a deductible and had a maximum out of pocket, so I thought I could negotiate that portion). The hospital turned me down and referred me to our insurer. My company insurer told me the name, CDHP, was a marketing name and that it did not mean I could negotiate anything. The insurer said, they had already negotiated all the fees and I was responsible for the deductible and maximum out of pocket. So much for a gimmicky name...
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