IMO the Major reason Health Care is so expensive is Doctors and Hospitals

[Toots]

not Insurance companies. Insurance Companies don't charge $53. for a pair of surgical gloves or twenty dollars for two aspirin, or four thousand dollars for a doctor to poke their head into your room for five minutes, never to be seen again. IMO it is the Hospitals and doctors that need to be shamed into pricing their services and goods at a price that is not simply astronomical. If Hospitals did not charge exorbitant prices then neither would the Insurance Companies. While I am not a fan of the Insurance Industry, I put the fault for such high costs on the Doctors and Hospitals and not nearly so much on the Insurance Companies. Something needs to be done to address this concern every bit as much as the other concerns like pre-existing conditions..

[NYC_SKP]

1. Hospitals charge these crazy fees to pay staff and overhead and cover the uninsured.

If you went to a large auto repair facility where half the cars that came in had to be repaired for free, parts AND labor, but you had insurance...

...a spark plug or vacuum line would cost hundreds or thousands of dollars.

I have no idea how widespread this problem is, but that's how it works at our four area hospitals.

[NJmaverick]

4. Plus hospitals are paying to comply with excessive regulation

and have to pay a fortune for things like hospital beds (cost as much as a new car) and anything else remotely medical.

[Donnachaidh]

9. excessive regulation?

You mean the sort that makes sure the patients don't get STAPH INFECTIONS during their stay? Or how about the regulations requiring doctors who put people to sleep during an operation have to KNOW WHAT THEY ARE DOING?



Yeah -- those *awful* regulations. It must drive numbers crunchers from the insurance industry nuts. :eyes:

[NJmaverick]

11. You have no clue what you are talking about

the hospitals have to answer to multiple regulatory agencies and produce reams of paper work to comply with intense and costly inspections. These inspections and regulations often to nothing for patient care but rather are part of Joint Commission trying to push the management techniques that are in vogue at the time. It's clear you have no idea how hospitals operate. I worked in the hospital industry for 15 years at not for profit hospitals so I can see just how ill informed you really are.

[nadinbrzezinski]

13. You mean like oh sanitary inspections?

You surely are kidding me.

By the way would rather have medical waste properly disposed (EPA and a few others) or just thrown out like it used to be? Local dumps used to be locus of infection in case you do not know this.

[NJmaverick]

17. You have no clue just how bad it is

For example you bring up regulated medical waste. In NJ an IV bottle is not considered medical waste while an IV bag is. The reason is the bags would wash up on the beach while the bottles broke. A regulation like that wouldn't make sense, but people who are clueless but like to put in their two cents wrote the regulations.

Still it's worse than that. One hospital I worked for had a professional building in it's facility. The doctor's regulated medical waste was picked up by the hospital staff and disposed of in accordance with all regulations. However the doctor faced a big fine because he didn't keep his own duplicate paper work. Again a case of people with no clue trying to run things.


I will not even get into the costs hospitals faced when they were pushed into buying on site incinerators by the state only to have to shut them down in a few years after the state changed their minds.


As for your clusters, that is just utter nonsense and conspiracy theory.

[nadinbrzezinski]

19. 1.- Brother IS a doctor, so yes I have a clue

2.- Dumps USED to be locii of infection... pick a book on the history of medicine. There are a few, but they do exist.

3.- SOME regulations might be out of place and exaggerated, your mileage will vary depending on the state you are in... as there are states that have more LOCAL regulations than others, see NJ, for example, but those regulations, like all environmental regulations have been written in blood. And yes, some things do not make sense... and your point?

4.- I could make the same argument you are making for a slew of other industries, such as the chemical industry, the HAZMAT industry (Talk of regulated), or for that matter the food industry. In fact, people make them all the time since they want those regulations taken off the books.

You may want to pick up and read Upton Sinclair's the Jungle for a reminder of what unregulated looks like. And many folks in these various industries would LOVE to return to that state of affairs. I guess you'd love to go back to a time when we took dirty bandages from the OR and threw them with the regular trash instead of ahem burning them.

[NJmaverick]

25. No need for relatives

worked first hand in hospitals and now I work in public health. So I know what is and isn't possible and claims that medical waste triggered some sort of outbreak or cluster by the dumps are simply impossible.

Secondly I appreciate that you admit I am right about excessive regulation and the costs involved.

As for regulations and hospitals I think what sets them apart from most industries is the shear number of agencies involved. You have the state departments of health, the local health depts, the NFPA, the FDA, Joint Commission (or similar entity), State and federal environmental protection and so on and so on.

[nadinbrzezinski]

34. I also worked in hospitals myself

and did public health work as well.

Again, you want all regulations OFF the damn fucking books?

And no, it does not set them apart. I ALSO did HAZMAT... hospitals and the health care industry have no regulations when compared to HAZMAT

[NJmaverick]

40. Your claims are false

I want to reduce not eliminate regulation. However your point of view was so out of touch that you were forced to make the false claim of complete elimination of regulation to prop up your bad claims.

Oh and I have worked with HAZMAT and have HAZMAT certifications as well as dealt with hazmat IN THE HOSPITALS so I am well aware of what they are dealing with.

I can also tell you about a hospital that got stuck with a clean up bill for an oil spill that had nothing to do with them, but it was easy enough for the County HAZMAT team to blame them and get them to foot the bill.

[nadinbrzezinski]

41. I asked you a question

and they're not false.

Have a good fucking life....

[NJmaverick]

43. Not very gracious are you?

[jody]

20. "Ignorance is a curable disease, stupidity is a terminal illness" Good luck treating those in need.

:thumbsup:

[Turbineguy]

5. Then lots of car dealers must be doing this.

Maybe I need to revise my attitude.

My dealer wants $650 for a sparkplug replacement. Lucky for me it was under warranty.

[NYC_SKP]

14. Back in the day you could do it yourself with a single tool.

With newer cars the number of things between you and the plugs often requires several steps just to get to the damn thing.

Now, get off my lawn!

:P

[Donnachaidh]

7. bullshit -- that's the official excuse they use

They charge these outrageous fees because they have a PROFIT LEVEL they wish to maintain, and they blame the uninsured for their greed.

Why do you think Hospital CEO's and doctirs who are involved in big practices get BIG salaries? It' ain't because of their *skills* - they are set up to rip off the consumers as much as the banks are.

And the poorest - the uninsured - are used to cover their GREED.

[NJmaverick]

10. If you understand the industry you would know that your are completely inccorect

there are many not for profit hospitals that are losing money and still charge the same rates.

[NYC_SKP]

16. San Joaquin General and St. Joseph's Hospitals are NOT for profit fucking hospitals.

Feel free to check for yourself.

To claim it is only because of profits is to distract from the real problems.

Distracting from the facts only perpetuates the problems.

Please ask someone who works in a hospital.

[NJmaverick]

18. facts mean nothing to this one

[dkf]

2. Hospitals should he required to post who gets charged what so we can see

The variability in billing. I think there should only be one price and it should be Based on the cost. Hospitals doctors and insurance companies have all gotten into the ridiculousness of this game. We need transparency.

[NYC_SKP]

21. I agree, exposure of the facts would shock people into insisting upon reform.

True for just about anything, like the defense budget.

[shraby]

3. The insurance companies don't actually pay those

exorbitant prices..they discount them drastically and only pay a percentage, then the insured pays part through the deductible. Yet every year the person carrying the policy sees their premiums raised and the deductible increased to the point where for most people, by the time the deductible is met, the year is over and the insured have to start all over meeting the deductible and having virtually no coverage at all, only premiums and deductible to pay and no benefit to speak of.

[TwilightGardener]

6. It is ridiculous. You can bet the hospital isn't buying a pallet of those gloves

from suppliers for $53 or whatever per pair--unless they're really bad at business. Doctors' fees, it's hard to say. But costs are in runaway mode, certainly.

[NJmaverick]

8. Pharmaceutical companies are the number one villain by a huge margin

Over priced drugs, slightly changed drugs to extend patents, drugs that only treat instead of cure and on and on. You want the low hanging fruit go after this industry's obscene profits. They will argue that it will hurt their R&D but I think the world can go with out another pill for an erection or longer and more lush eye brows.

[nadinbrzezinski]

12. And you'd be wrong

those fees are charged to cover things like oh staff. (Aspirins, take a guess how many people HANDLE that aspirin request)... as well as to cover the uninsured and charity cases.

They'd go down the moment we had NATIONAL HEALTH CARE, single payer. The economics change like in an instant...

[jschurchin]

15. Emergency rooms, and NOT being able to turn

anyone away without treatment. Say you owned a plumbing business and the guberment told you "Toots, the law say's you must provide EVERYONE with a hot water tank regardless of their ability to pay you." Now 7,500 people live in your town, 5,000 can pay you, the other 2,500 can not. Now the ones that can afford to pay, you charge $1,000 for a $500 tank because you have to provide 2,500 people with a tank they cannot pay for.
Does the blame lay with Toots? IMHO, No it does not. You cannot survive giving away your services. Neither can a hospital. It's the bureaucracy of Healthcare in America thats killing the system. $2,200,000,000,000 and it's NOT ENOUGH to cover 300,000,000 people.

THEIR FUCKING KIDDING ME, RIGHT?

[nadinbrzezinski]

22. IT used to be that hospitals did walletcoscopies

before allowing a patient in from the back of an ambulance... that was in the 1980s.

In case you wonder people died.

You want to go back to those times?

Oh and the prices were still insane.

[NYC_SKP]

27. They did that to me in 1991...

Ex-wife and I were in a boating accident.

She worked for FedEx, I worked for out of state firm.

Taken to hospital, I had no wallet, just story that I had Blue Cross for out of state job, no proof of this.

She had a cut on her hand, was admitted and spent the night.

I was released, no outward signs of trauma, but seriously out of breath and in pain.

I had to go back after going home, I had collapsed, abdomen severely bloated, pale skin.

What did they find, what were my injuries in triage that they missed?

Ruptured spleen, punctured lung, four broken ribs, 4 liters of blood were removed from my cavity.

Lucky I didn't die.

[nadinbrzezinski]

35. I could tell stories

sadly from two countries. The joy of working in a border town.

[jschurchin]

32. "In case you wonder people died."

Yeah, people die every day. It's the one downside to being born.

You want to go back to those times?

I do not. WHAT I WANT is a single payer health care system. I want every dollar that is payed, right now, to be placed into a single healthcare pool. We spend close to 18% of our Gross Domestic Product on health care. It's fucking ridiculous. Look at what, for profit, healthcare insurance company's make. It's fucking obscene. Just the top 5 in the 4th quarter reported $12 BILLION PROFIT. How many Americans could that provide health care too?

Thats just the top 5. At last count there were 3,400 health insurance providers in America. And although the vast majority are NON-PROFIT, don't believe that bullshit. UPMC healthcare here in Pittsburgh is a non-profit. Their NON-PROFIT just payed over a BILLION non-profit dollars to rehab a old building and make it the new Children's hospital.

There is only one answer. SINGLE PAYER. We pay enough already to cover everyone. As long as the middle man is alive and well, we are FUCKED.

[nadinbrzezinski]

36. Yes that is the answer

but the reason why they cannot refuse care these days (and they find ways to do it anyway) is because of the few scandals in the 1980s of patients who died in the back of an ambulance, in particular in Vegas, but in other states as well.

One of my patients, we took him from ER to ER to ER, until finally a local family clinic accepted him, and he died partly because he did not get timely care.

That is what we call in the field an unnecessary death.

[cowman]

39. I'm with you

I'm Paramedic with LVFR and we usually transfer our patients to the local Ambulance services here in Vegas and they tell us that it's not unusual to wait for 1-2 hours to get a bed in the E.D.

[nadinbrzezinski]

42. San Diego has still similar issues

and I did this in TJ, but we got to transfer patients to the US from time to time.

I got it when a hospital said no if the ED was on stand bye or did not have the proper equipment. But I had the head nurse (hospital to remain unnamed) flatly tell me... "take him somewhere else, he does not have insurance."

I *was livid* This was a patient who was a charity case. I did not have the time for those games, and wasn't even in MY jurisdiction.

Of course I can also tell the story that told me how broken the system was oh decades ago...

Shall we say that particular patient, I called MY dispatch and took patient straight to County. When county tried the same game, I flatly told them, have YOUR EMS do the transfer. They accepted the patient... but not with any joy. I know, Patient was a frequent flyer... of course he was, he needed dilantin...

[mmonk]

23. Then you are not informed (concerning our health insurance industry).

[kirby]

24. Doctors/Hospitals charge the MAX they can...

Doctors/Hospitals charge the MAX that insurance will reimburse. Those who are uninsured are charged (put perhaps never pay) an even higher maximum. There is very little incentive in the system to save money.

The WHOLE system is fucked.

[NJmaverick]

26. Hospitals have been going out of business over the past few years

and have been having continual lay offs. How do you explain those facts?

[kirby]

28. There are many factors...

They spend too much versus what they charge. For one, they get into 'arms race style wars', spending lots of money to have the latest machines to compete with other hospitals. Secondly, the uninsured are a huge burden. Many of the public hospitals treat anyone, but may not get paid. They try to pass those costs onto patients who are insured by jacking up the cost of an aspirin, but the insurance companies put a cap on that so it only absorbs to much. Illegal immigration has really hurt hospitals along the border. The lack of lending has made it much harder for hospitals to raise money via bonds. Believe it or not, many hospitals raise money from wealthy donors (to cover the shortfalls and subsidize the uninsured) - those donations have dried up as the peoples 'wealth' took a beating over the past several years.

[NJmaverick]

30. Many of your points are correct

the donors, the uninsured and the illegals. However in some states, such as NJ the hospitals are not allow to bill others for the uninsured. Instead the state pays them pennies on the dollar for the cost of treating the uninsured. As for competing for the newest machines, that isn't correct. In many cases the imaging procedures are one of the few things a hospital can do that actually doesn't cost them money.

Hospitals have been squeezed for years by medicare (that has been reducing what they pay hospitals for a given procedure) and powerful HMOs that negotiate harsh deals with hospitals. Going back to medicare they pay per incident rather than actual cost. So if someone comes in with a broken hip they only get x dollars (which has been gradually reduced over the years). Now in well to do areas a hospital can usually get by on these meager payments, however in inner cities where people tend to wait before getting care or have many other complications the hospitals suffer losses on these payments. That is why you are seeing the poorer areas being especially hard hit with closures.

[kirby]

33. One issue...

I'll still disagree about capital money being spent on expensive medical equipment to compete with other hospitals. Many times multiple hospitals in a few mile radius will all pay for the same equipment (or upgrade to be better) rather than share. They also advertise how their 'machine' is better, when the extra resolution probably means nothing for 90% of the people using it. The machines are very expensive, with very high maintenance costs.

I do agree about medicare payments being an issue.

That is why I said the WHOLE system is screwed up. It is not fair of the OP to single out hospitals/doctors, but they share part of the blame.

[napi21]

29. The fault of excessive costs is NOT the hospitals & Docs!

IT also doesn't make sense, to me at least, to itemize the details of each cost on every bill. Very few consumers would understand if they did.

I did cost accounting for a tablet/capsule manufacturer for years and I'd be retired as a millionair if I had gotten a quarter for every time I was questioned & derided by veople who were very intelligent in their field of expertiese but were absolutely positive that MY COSTS WERE WRONG!

Although my job was not in a hospital atmosphere, my closest friend is. Even I didn't realize how short the "usefull life" of much of the equipment is that is used in a hospital. The usefull life of an MRI machine can be less than ONE YEAR and a new one costs over $20 Million! That doesn't mean that the one that is only one year old doesn't work anymore, but the new one gives much better and more refined information to the Docs and both the Docs & the patients want access to the BEST. \

It is also true that the BIGGEST expense a hospital has is that of treatment of patients who cannot pay for it. Those costs are allocated acroll the board to everything, and you & I have to pay to cover them.

[Beetwasher]

31. You Have Got To Be Fucking Kidding Me

When you pay an "astronomical" fee, you are paying for all those people who CAN'T FUCKING PAY because they don't have insurance. There are A WHOLE SHITLOAD of them and yes, prices are jacked up quite a bit because of them. If everyone were covered, that would be a huge savings and costs for procedures would stabilize.

Additionally, hospitals have very, very large overhead.

Not all hospitals are for profit entities you know.

[PHIMG]

37. WRONG!! Insurance companies add $400/yr billion in unneccsary costs

You know $50 for surgical gloves is ridiculous but at least there is VALUE THERE. It stops the spread of disease.

What value do insurers add to our system: ZERO. Medicare can do what the insurers do, less all of the heartache and abuse and dirty dealings, for a lot less.

Medicare spends 97 cents of ever dollar on care, private insurers are like 70-85 cents only.

The difference between these two ratios is stuff the private insurers spend on like expensive corporate headquarters, million+ executive salaries, executive "retreats", bonuses, underwriting, marketing, etc.)

It not just the money the insurers waste its all the money the hospitals have to spending on billing clerks fighting with the insurers to get paid. It's an arms race between hospitals staffing up to deny claims and providers staffing up to fight claim denials.

The total is $400 billion in savings to moving to Medicare for All.

We can cut out the insurers VERY EASILY and use this money to cover everyone. It's called Improved Medicare for All, in H.R.676 and S.703. The only thing we lack is the will from politicians in DC. Sold out whores to big insurance and wall street.

Reining in hospital and doctors fees is much more tricky but Improved Medicare for All does that too with cost control measures such as fee negotiation for providers, global budgeting for hospitals and bulk purchasing for drugs and durable medical equipment, etc.

MEDICARE FOR ALL is the answer. It saves billions and uses the money to give everyone in the U.S. Cadillac healthcare from cradle to grave with not one dollar in out of pocket cost.

The insurers are a HUGE problem. Private Insurance Must Go! MEDICARE FOR ALL NOW.

[Yavin4]

38. Our Health Insurance System Is Based On Employer Provided Health Insurance

Our system was based on people having one job their entire lives with good benefits. We all know that that system stop existing in the 1980s, and we've done nothing to replace it.

We live in an uncivilized, barbaric, predatory capitalist structure that feeds on the weak and defenseless. We do so because a large number of us believe that one day we will all be wealthy like Warren Buffet, and we don't want to pay any taxes. It's absurd.

Hospitals and doctors charge so much because the insurance companies reimburse so little and the cost of treating the uninsured has to be recovered from the insured. End of story.