Just one example of what is wrong with the US health care system

[Gerarddm]

I sliced open one fingertip with a chisel during boat school a few weeks ago. One of my fellow students, an RN, patched me up and opined that I might need stitches and certainly a tetanus booster shot. So I go over to the nearest hospital emergency room. They irrigate the wound thorughly, bandage it up ( no stitches ), give me my tentanus shot, and send me on my way. Total time in the facility, literally: somewhere between 30 and 40 minutes.

Anybody want to guess what the bill was from the hospital?

$807.90

AND they caution that this is for hospital services only, that physician services are not included.

My insurance covered $715.61, leaving me to pay the cash balance of $92.29.

Blows me away.

[Steve McMahon]

And I get ticked off that every time I go to the hospital it cost's $2.00 to park unless I want to park down the street and walk a few blocks! I guess I won't complain.

[Bobby of Tulsa]

My only gripe is, all the people that line up out side the ER. They all say, We come here because we cant afford a doctor. What they mean is we don't have to pay here.

[skuthorp]

If it looks like a racket and smells like a racket it is a racket.

[George Jung]

Bingo. What I typically advise my patients is - if it's not lifethreatening/really serious, call me. If I'm at home, I'll pop over to the clinic and evaluate it. Either I can fix it, or I can't. And my charge is fractional what the ER charges. This was brought home when one of my friends got socked for $800 (must be 'entry level) for a bladder infection. And that was before the dr. charge, and before she received an antibiotic. It oughta be criminal. That it's not, speaks volumes.

[P.I. Stazzer-Newt]

How much would a vet have charged - Around here that's at £15 worth of a vet's time - and they don't expect the patient to answer stupid questions or fill in unnecessary forms.

[Michael D. Storey]

In another similarly directed thred, I suggested that a source of this prob was the lack of competition. I was booed off of the stage, when people started to carry on about the need for a gov't-run/sponsored system.

I hold to my original thesis. If there is money to be made in this sort of work, and the patient can save money, then the patient will shop the more cost-effective place to get the service performed. Not a 100% solution, not for all cases, but competition can have a downward pressure on price. Consider it for standard procedures, meds, equipments, therapies, etc.

[John Smith]

Don't you all know: This is the best system in the world? I am kidding.

[CWSmith]

I sliced open one fingertip with a chisel during boat school a few weeks ago. One of my fellow students, an RN, patched me up and opined that I might need stitches and certainly a tetanus booster shot. So I go over to the nearest hospital emergency room. They irrigate the wound thorughly, bandage it up ( no stitches ), give me my tentanus shot, and send me on my way. Total time in the facility, literally: somewhere between 30 and 40 minutes.

Anybody want to guess what the bill was from the hospital?

$807.90

AND they caution that this is for hospital services only, that physician services are not included.

My insurance covered $715.61, leaving me to pay the cash balance of $92.29.

Blows me away.

One of the goals of "Obamacare" is to limit the emergency room for emergencies (not that this wasn't). Hospitals have to pay to have those expensive tools available whether they use them or not.

[hokiefan]

One of the goals of "Obamacare" is to limit the emergency room for emergencies (not that this wasn't). Hospitals have to pay to have those expensive tools available whether they use them or not.

Several years ago my daughter broke her wrist playing basketball. Wasn't obvious, but later that afternoon decided to take her to the ER. Was the first weekend in January and my employer had just changed insurance providers, so there was a screwup with the insurance. While getting that taken care of I confirmed with the insurance company that the hospital I chose was in network. Then I asked how emergency visits were handled if you picked an out of network provider. Was told that emergency visits were covered regardless at the in-network rate. But a broken wrist did not qualify as an emergency visit. ????

Cheers,

Bobby

[CWSmith]

But a broken wrist did not qualify as an emergency visit. ????

Cheers,

Bobby

It seems we are at their mercy (insurance companies) and this is where Obamacare falls short.

[Shang]

It seems we are at their mercy (insurance companies) and this is where Obamacare falls short.

Exactly.
The "Single payer" system should have been the first part of the Affordable Care Act to go into effect. President Obama should have dug in his heels and fought for this.
On the other hand, the Republicans should not have fought to preserve the strangle hold of the for-profit insurance companies. The present system is inhumane and financially ruinous.

In a single payer system the government or a government regulated non-profit agency channels health care payments to collect premiums and settle the bills of medical providers instead of for-profit insurance companies. Many countries use single-payer systems to cover all their citizens.

The over 1,300 U.S. health insurance companies have different forms and processes for billing and reimbursement, requiring enormous costs on the part of service providers (mainly doctors and hospitals) to process payments. For example, the Cleveland Clinic, considered a low-cost, best-practices hospital system, has 1,400 billing clerks to support 2,000 doctors.[95] Further, the insurance companies have their own overhead functions and profit margins, much of which could be eliminated with a single payer system. Economist Paul Krugman estimated in 2005 that converting from the current private insurance system to a single-payer system would enable $200 billion per year in cost savings, primarily via insurance company overhead. One advocacy group estimated savings as high as $400 billion annually for 2009 and beyond.

[Bruce Taylor]

Dr. SWMBO just reminded me that, back in the nineties, when she was finishing her residency, she talked to a medical recruiter from one of the big American hospital groups. The recruiter referred, in an offhand way, to the many happy and well-remunerated physicians her company owned!

[Peerie Maa]

In another similarly directed thred, I suggested that a source of this prob was the lack of competition. I was booed off of the stage, when people started to carry on about the need for a gov't-run/sponsored system.

I hold to my original thesis. If there is money to be made in this sort of work, and the patient can save money, then the patient will shop the more cost-effective place to get the service performed. Not a 100% solution, not for all cases, but competition can have a downward pressure on price. Consider it for standard procedures, meds, equipments, therapies, etc.

If there is to be competition, there needs to be more supply than demand. That means several hospitals with empty beds in all areas. The overheads of maintaining those unused facilities will also drive up the costs.

[John Smith]

Several years ago my daughter broke her wrist playing basketball. Wasn't obvious, but later that afternoon decided to take her to the ER. Was the first weekend in January and my employer had just changed insurance providers, so there was a screwup with the insurance. While getting that taken care of I confirmed with the insurance company that the hospital I chose was in network. Then I asked how emergency visits were handled if you picked an out of network provider. Was told that emergency visits were covered regardless at the in-network rate. But a broken wrist did not qualify as an emergency visit. ????

Cheers,

Bobby

The insurance companies, for years, have defined "emergency" as life threatening. This is, of course, rediculous to anyone but an insurance company. One of the problems has been companies looking for new ways NOT to pay benefits.

[John Smith]

It seems we are at their mercy (insurance companies) and this is where Obamacare falls short.

Interesting statement, I saw an interview with Ron Paul today in which he commented on how things will get worse under Obamacare, but he was not pressed as to how. I think Obamacare, even when fully implemented falls short because it is still employer based.

Other that that, so far all those bad things predicted in regard to this bill have not come true, but the bill is not fully in place. If this trend continues, it may not fall as short as you think.

[George Jung]

Any here ever see this?

http://www.healthcarebluebook.com/

You may find it interesting and perhaps even helpful.

[CWSmith]

Interesting statement, I saw an interview with Ron Paul today in which he commented on how things will get worse under Obamacare, but he was not pressed as to how. I think Obamacare, even when fully implemented falls short because it is still employer based.

Other that that, so far all those bad things predicted in regard to this bill have not come true, but the bill is not fully in place. If this trend continues, it may not fall as short as you think.

I think the theory is (1) get routine care out of emergency rooms where it's expensive, (2) get basic maintenance for everyone so we avoid some of the expensive stuff, (3) get everyone covered because it's the moral thing to do, and (4) cost will come down.

The only thing I doubt is 4, unless we force it on the insurance companies, but time will tell.

[AndyG]

...There's also the profit margin of the hospital...

Wow. If anything makes the Atlantic real for me, it's the use of "profit margin" and "hospital" in the same sentence. You should come over to the UK and chisel your fingers. It hurts and bleeds the same, but it's loads cheaper.

Andy

[john welsford]

A good freind of mine, American, not a citizen, resident or taxpayer here, took two fingers off on a table saw while working on his boat here in NZ. 17 minutes after the accident I pulled up outside hospital emergency room, they stretchered him in, about a 3 or 4 minute wait to get the orderlies and stretcher out to him, and took him directly into the triage unit. (I'd fished his detached parts out of the sawdust and wrapped them in wet cloth with frozen peas to chill them and they went with him, the nurse did not even blink when I fronted up to the counter and put these on the bench, said "these are my friends fingers and he's outside in the car, please can we get some help to get him in here")
Emergency treatment, two days in hospital, operation under general anasthetic in theatre to get the stumps tidy and all the bone chips extracted, a day follow up in hospital, visits to the twice a week for dressing changes and eventually stitches out, painkillers and other drugs, cost to him? Zero. Financial that is, there is a cost in that his hand is not as useful as it was.
New Zealands "Socialist" health system is not perfect, but it does pretty well.
Our tax rate? The best indication I can find is that its about 3% higher than equivalent incomes in the USA, and we get universal pensions as well.
John Welsford

I sliced open one fingertip with a chisel during boat school a few weeks ago. One of my fellow students, an RN, patched me up and opined that I might need stitches and certainly a tetanus booster shot. So I go over to the nearest hospital emergency room. They irrigate the wound thorughly, bandage it up ( no stitches ), give me my tentanus shot, and send me on my way. Total time in the facility, literally: somewhere between 30 and 40 minutes.

Anybody want to guess what the bill was from the hospital?

$807.90

AND they caution that this is for hospital services only, that physician services are not included.

My insurance covered $715.61, leaving me to pay the cash balance of $92.29.

Blows me away.

[RichKrough]

Here in the Albany NY area we have a number of so-called urgent care clinics. These provide walk in services for things like minor broken bones. wound care etc. Under my insurance if I were to go to ER for a cut finger I would be paying about 1/2 of that $900 ER bill. If I go to an Urgent Care clinic first I have no co-pay and it is a helluva lot shorter wait time than in a ER room.
Several of the local hospitals which are losing revenue because of the urgent care clinics are now opening their own urgent care centers with-in the hospital. In those hospitals if you go to the ER with the cut finger they will triage you when you check in and then send you to their urgent care section , From a cash standpoint it is a difference of about $600.

[Michael D. Storey]

If there is to be competition, there needs to be more supply than demand. That means several hospitals with empty beds in all areas. The overheads of maintaining those unused facilities will also drive up the costs.

Well that sure is dumb. If the demand is less, the supply will fight to get it; lower costs, spouse stay overs, etc.
Think about it.

[Peerie Maa]

Well that sure is dumb. If the demand is less, the supply will fight to get it; lower costs, spouse stay overs, etc.
Think about it.

Tighter margins, corners cut, cleaning and hidden activities outsourced to the cheapest without consideration of competence leading to infections. And the shareholders still queuing up with their hands out.

You should not expect to be making a profit out of those who'r prevented from earning disposable income through illness. There is another better (not so dumb) way.

[Osborne Russell]

Bingo. What I typically advise my patients is - if it's not lifethreatening/really serious, call me. If I'm at home, I'll pop over to the clinic and evaluate it. Either I can fix it, or I can't. And my charge is fractional what the ER charges.

That's the way it used to be. I still can't figure out how the insurance companies took over.

If there's so goldang much money in health care, what's stopping the doctors from cutting off a piece for themselves?

[George Jung]

1) Hospitals and hospital owned clinics are 'allowed' to charge more than are independents. 2) Most of us inclined to being independent charge what we think is 'fair' - and it's considerably less than what Hospital owned docs charge. I wouldn't have the cajones to charge like that - but that's also why it's tougher to make it on your own. 3) dealing with insurance companies and the Govt. is a royal PITA. 4) EMRs are a royal PITA - and expensive.

Don't discount the PITA angle; most docs would love to be independent.

[Orange]

It is crazy how much hospital expenses can be. I recall a visit to the emergency room for a few hours cost me a little over $2000 eight years ago. I had caught what was probably a severe stomach bug from my sister, and it was recommended I go to the ER. All they basically did though was park me in front of the bathroom, gave me an IV, and then discharged me a few hours later. Basically, it was a pricy pay toilet stop.

Another problem with medical costs in how little is paid into Medicare. Elderly patients under todays program receive 3 times more in services than what they paid into the system. It's one the main reasons why the nation is broke. Reform is needed. Thought John Stossel had a nice article about the problem today.

"Free" Wheelchairs

Snippet from the article:

...Medicare recipients complain that it's unfair to call Medicare a taxpayer handout, because they paid into the system when they were working, but most don't realize that Medicare is not insurance. It's just another government program, and the most wasteful one. Today many elderly people collect three times what they paid into Medicare.
This is unsustainable.

Read more: http://www.foxbusiness.com/on-air/st...#ixzz1j0r4iBP9

[David W Pratt]

Gerrard-
Good thread, but you should have included "chisel" in the title.

[PhaseLockedLoop]

If there is to be competition, there needs to be more supply than demand. That means several hospitals with empty beds in all areas. The overheads of maintaining those unused facilities will also drive up the costs.

Well that sure is dumb. If the demand is less, the supply will fight to get it; lower costs, spouse stay overs, etc.
Think about it.

OK. I've thought about it. You've got a real good idea there, which apparently no one in the hospital business has thought of. Why don't you set up a hospital with cut-rate doctors and used equipment and maybe trailer add-ons for rooms, and advertise with a "SAVE MONEY!" sign. Gotta be a winner.

[George Jung]

The building does not the Dr. make.... would you agree? One of my big beefs with 'big medicine' is this mindset that hospital campuses have to be like the taj mahal. A friend recently commented that hospital campuses are this generations cathedrals - opulent, exaggerated, expensive, and generally incredibly inefficient. Someone has to pay for that.

[Nicholas Carey]

The building does not the Dr. make.... would you agree? One of my big beefs with 'big medicine' is this mindset that hospital campuses have to be like the taj mahal. A friend recently commented that hospital campuses are this generations cathedrals - opulent, exaggerated, expensive, and generally incredibly inefficient. Someone has to pay for that.

A big part of that is that in these days of for-profit hospitals, hospitals have to compete for patients...err..."customers". That means upping the ante WRT to creature comforts.

[Jim Bow]

My only gripe is, all the people that line up out side the ER. They all say, We come here because we cant afford a doctor. What they mean is we don't have to pay here.

Nope. What they mean is they can't afford medical care. When I visited Costa Rica in 1997, a friend jammed a thorn under his fingernail. It broke off and hurt like hell. He went to a local doc who numbed it up and got the stuff out, thoroughly cleaned and patched the wound, and sent him on his way. $15.00. Also in the clinic was a woman who had, earlier, put her fist through a window and was rushed to the local ER with massive bleeding. She was at this local office for a checkback. ER costs = $15.00, checkback cost = $15.00. The doc was a graduate of Duke University Medical School.
BTW: in 1947 Costa Rica eliminated its military and put the money into education and health care. Results: 99% literacy, and longer lifespan than the US by far.

[George Jung]

I'd have to disagree, Nicholas. People aren't looking for a massive granite building in which to receive their medical care. They're looking for a person who is kind, well-trained and knowledgeable, who is in a position to provide that care in an effective manner. That may be in a very fancy building, or a much more modest setting. What they don't want is to feel they're being told to grab their ankles everytime they come through the door.

[Nicholas Carey]

I'd have to disagree, Nicholas. People aren't looking for a massive granite building in which to receive their medical care. They're looking for a person who is kind, well-trained and knowledgeable, who is in a position to provide that care in an effective manner. That may be in a very fancy building, or a much more modest setting. What they don't want is to feel they're being told to grab their ankles everytime they come through the door.

I don't disagree with that. But what people want/need is only tangentially related to how they are marketed to. Hospitals have gotten glitzier as a means towards standing out from the pack. Hence the vast oversupply of MRI scanners around the country. I just read a piece on the latest boondoggle, some new form of imaging that basically requires a particle accelerator. Very expensive. Very not needed. But everybody seems to be wanting one.

And once you have an oversupply of all this very expensive equipment...it's get used, thus driving up everybody's costs.

[Presuming Ed]

http://krugman.blogs.nytimes.com/2011/04/24/the-language-of-medicine/

http://www.nejm.org/doi/full/10.1056...98204083061409

[George Jung]

I don't disagree with that. But what people want/need is only tangentially related to how they are marketed to. Hospitals have gotten glitzier as a means towards standing out from the pack. Hence the vast oversupply of MRI scanners around the country. I just read a piece on the latest boondoggle, some new form of imaging that basically requires a particle accelerator. Very expensive. Very not needed. But everybody seems to be wanting one.

And one you have an oversupply of all this very expensive equipment...it's get used, thus driving up everybody's costs.

Agreed. When you have a hammer, everything looks like a nail.