Health care pt5

[kvrdave]

Originally Posted by CRM114

Is this an assumption?

It's a joke about the catch-22 nature of it. If they don't limit things, prices will go up as the practice continues and will get worse as hospitals order more and more tests to make up for the amount the government in willing to reimburse for the tests. Or they can limit the tests and hold prices down while people revolt at the shit sandwich they were forced to eat.

But they will eventually be forced to ration, just like all the other healthcare systems.

[orangecrush]

Originally Posted by CRM114

I think you need to have lived through a serious medical issue to get it.

I don't think the fears of over-testing are for those with serious medical issues.

[hahn]

Originally Posted by Venusian

So how would having a public option fix this? Or worse a single payer?

Why wouldn't the doctors still order every test since the govt is footing the bill now?

I didn't say a public option would fix this. I'm saying that health insurance in general, whether private or public is a flawed idea. Health insurance is only part of the problem though. Doctors order a lot of tests that are unnecessary, but I'm not saying it's their fault. They cover their asses because of fear of lawsuits from a public that expects ZERO error from their physicians. And by zero error, I mean they expect that they shouldn't miss anything. Ever. That's not entirely the public's fault either though because they've been told that the U.S. healthcare system is the best in the world because it's doctors are the most knowledgeable and we have the most advanced technology. It's not true, but most people believe it. I would say most do it to cover their asses more than to make money, but I know of at least several cases through friends of mine (also physicians) from back East, where a certain department in a certain hospital orders a certain expensive test on EVERY SINGLE patient that gets referred to them just because they paid a lot of money for a cutting edge technology piece of machinery that does this test. Your eyeballs would pop out of your head if you knew how much was being charged.

And really, who's going to argue that it's unjustified? As physicians we can order pretty much whatever we want if we can come up with a reasonable suspicion. And it's really not that hard to come up with a reasonable suspicion for just about anything. But the question of how "reasonable" is defined is where the debate gets sticky. There are a lot of "unreasonable" tests or procedures done that out of sheer luck happen to be a good decision. So then it becomes hard to argue what was reasonable and what isn't. A lot of it is shaped by a physician's own experience. And unfortunately, yes, there are *some* highly immoral physicians out there who will use this to their advantage to maximize their charges. But how do you prove that? You can't.

But this is not a problem with a single factor. Many other things contribute to high costs and it's hard for me to say how much overtesting contributes compared to others (drugs, medical equipment, etc).

[Pharoh]

Originally Posted by Pharoh

Could anybody give me some information on the health care bill possibly slated to go to the Senate floor, since I haven't read it yet? Will the public option be available to everyone, or only those under a certain economic threshold?

That was my original understanding while the bill was in committee, but I am not sure if it is still true.


By the way, the rationale given for this was because the proponents didn't want to destroy the private health insurance industry. But doesn't this type of system, if true, invalidate the competitive aspects?

I think I discovered the answer. Only those without access to employer provided insurance will be eligible for the public option, and even then those below an income threshold.

How in the world is this going to provide any competition, competition supposedly necessary to bring down costs?

[hahn]

BTW, as an aside, there was a recent NY Times article that talks about the American Cancer Society and how they're finally admitting that the benefits of cancer screening are overstated. LINK This is something I've been arguing for years now and I'm glad it's finally put out there for discussion. It's one of those things that if you repeat often enough, everyone believes it's always true. Food for thought in this healthcare discussion.

[JasonF]

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"

[orangecrush]

Originally Posted by JasonF

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"

If you had told me it was 10,000 to 1, I would have taken it. Because, we all know if someone gives you 10,000 to 1 on anything, you take it. (Indecently, if John Mellencamp ever wins an Oscar, I am going to be a very rich dude)

[kvrdave]

Originally Posted by hahn

It's one of those things that if you repeat often enough, everyone believes it's always true.

Just like there being a "health care crisis."

Hell, there is a budget crisis and a national debt drisis, but a health care crisis? Bah!

[CRM114]

Originally Posted by orangecrush

I don't think the fears of over-testing are for those with serious medical issues.

Who is it for?

[CRM114]

Originally Posted by Pharoh

I think I discovered the answer. Only those without access to employer provided insurance will be eligible for the public option, and even then those below an income threshold.

How in the world is this going to provide any competition, competition supposedly necessary to bring down costs?

I suppose that since healthcare coverage will be mandated, the public option will now have 30-40 million potential subscribers that the for-profits will want to snag as well. They will need to lower their rates to capture those customers.

But it's all nonsense. Single-payer, Medical for All is the only true solution but no one has the ability to communicate this without being called a Communist.

[hahn]

Originally Posted by JasonF

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"

That's my point. People have zero tolerance for risk. Both patients and physicians. But then if you run a that CT scan on 1000 people just to catch that one person's brain tumor. Then you have to deal with the question of what % of the time is it treatable because what's the use of catching an untreatable brain tumor? So then is it worth it?

Before you say yes too quickly consider this hypothetical. What if there's a very expensive treatment that costs $100 billion dollars but will guarantee a cure for an otherwise fatal disease that only occurs in 10 people per year. Do we absorb $1 trillion dollars of cost (obviously these people can't pay it) in the healthcare system to cure these 10 people? Obviously I've exaggerated the circumstances here to make a point, but I hope you see it.

[CRM114]

Originally Posted by JasonF

In terms of ordering too many tests, it's very easy to say in the abstract that doctors shouldn't perform a very expensive test to rule out a disease or condition that has a very small chance of being present. But if your doctor comes to you and says "It's 99.9% likely that you just have a simple headache, but 0.1% likely that you have a brain tumor that will kill you if we don't treat it. We need to conduct a CAT scan to know for sure," how many people will say "A 1 in a thousand chance of me dying from a treatable condition? Don't give me the test -- I'll play those odds!"

I had (what was never officially diagnosed as) "viral meningitis." They had to do tons of tests including a spinal tap to rule out "spinal meningitis." I'm glad they did whatever tests necessary to make me well. By the way, they told me that to diagnose it as viral meningitis FOR SURE, they'd have to do a bunch of other tests which they didn't bother doing since VM just goes away on it's own.

[orangecrush]

Originally Posted by CRM114

Who is it for?

People w/ runny noses and headaches. Let's face it, even 1000 to 1 is still pretty good

[orangecrush]

Originally Posted by CRM114

But it's all nonsense. Single-payer, Medical for All is the only true solution but no one has the ability to communicate this without being called a Communist.

It isn't the only solution for every country w/ a system different from our own.

[CRM114]

Originally Posted by hahn

Before you say yes too quickly consider this hypothetical. What if there's a very expensive treatment that costs $100 billion dollars but will guarantee a cure for an otherwise fatal disease that only occurs in 10 people per year. Do we absorb $1 trillion dollars of cost (obviously these people can't pay it) in the healthcare system to cure these 10 people? Obviously I've exaggerated the circumstances here to make a point, but I hope you see it.

Yes since obviously nothing would cost billions of dollars. That is the point of insurance. What's the difference between that and us "absorbing" the cost of performing 5 open heart surgeries on some 500lb blowhard?

[CRM114]

Originally Posted by orangecrush

People w/ runny noses and headaches. Let's face it, even 1000 to 1 is still pretty good

I never was tested for anything with a runny nose and headache. Add vomiting though and yes.

[CRM114]

Originally Posted by orangecrush

It isn't the only solution for every country w/ a system different from our own.

I thought all the other countries had socialized healthcare and therefore it was horribly substandard? (Except Singapore, apparently. )

[Dr Mabuse]

Originally Posted by orangecrush

It isn't the only solution for every country w/ a system different from our own.

Exactly.

It's no accident you never see an excellent example like the French model looked into in the propaganda war that is the 'health care debate'.

It's most always Canada or Britain, because the masters of information have put together 'why it's bad' arguments on those two.

[Pharoh]

Originally Posted by CRM114

I suppose that since healthcare coverage will be mandated, the public option will now have 30-40 million potential subscribers that the for-profits will want to snag as well. They will need to lower their rates to capture those customers.

But it's all nonsense. Single-payer, Medical for All is the only true solution but no one has the ability to communicate this without being called a Communist.

It likely is more 15 to 20 million, people who aren't going to be courted by the private insurers regardless. There simply isn't going to be any competitive aspects that will aid in the lowering of costs.

We are going to get a fully broken system that makes things worse, or a system that necessarily leads to a single payer system so favourable to yourself. I just wish the discussion was honest.

[hahn]

Originally Posted by CRM114

Yes since obviously nothing would cost billions of dollars. That is the point of insurance. What's the difference between that and us "absorbing" the cost of performing 5 open heart surgeries on some 500lb blowhard?

The point is that there is a price point at which one would say this is no longer worth the cost to insurance pool of money. Everyone may have a different price threshold, but the point is that there IS one. We continue acting as if health is priceless and that we should do anything and everything to ensure that everyone is healthy all time and we should spend lots of money to make sure there isn't even the possibility that there could be something we're missing. It's the inconvenient truth of healthcare - health has a price tag.

Regarding your story, I wouldn't argue that you were overtested. And I would point out that I didn't say that everyone and every case is overtested. Just that many are. To be honest, I don't have a good idea of how bad the problem is. I don't have specific figures on how much overtesting is costing the system. No one does. Because overtesting is not an objective measurement and so it's difficult to get an accurate picture.

[orangecrush]

Originally Posted by CRM114

I thought all the other countries had socialized healthcare and therefore it was horribly substandard? (Except Singapore, apparently. )

It may shock you to know that I actually think that our system has more problems than this guy:


I just think our system would do better if people had more incentives to reduce costs than it would if it were Medicare+ But I can admit it when I am wrong. If we get Medicare+ and it turns out roses in the long run, I will buy you a beer. Just don't make me buy you a PBR.

[maxfisher]

Originally Posted by hahn

get my "facts" from the companies' own financial statements. 2.2% on $100 would not be a lot. 2.2% on $45 billion is $3.3 billion. That would be United Healthcare in 2006. Fortune 500 list of health care insurance companies and their revenue/profit from 2006. And actually, if you look up the annual financials on Google or Yahoo Finance, they ended the full year of 2006 with a profit of $4.2 billion. In 2007, they made $4.6 billion.

Let's compare that to a company that most would recognize and consider to do quite well: Apple. In 2007, Apple had a net profit of $3.5 billion. In 2006, their net profit was $2 billion. So you're going to argue that United Healthcare's profits aren't very big?? You're being fooled by the percentage of profit margin. It might seem slim, but the revenues are so huge, it's a gigantic chunk of change. And unlike most other industries, they have very tight control over their costs through denials of claims.

So you think it's just totally irrelevant that United Health Group's revenues were over 350% of Apple's in 2006 and over 300% of Apple' in 2007?

Also, who do you think that 'gigantic chunk of change' goes to? Who do you think owns the health insurance companies? Do you really believe those owners don't deserve a return on their money?

Originally Posted by hahn

I don't believe that any of those for-profit companies listed have EVER had a loss in any fiscal quarter. EDIT: I just Googled and couldn't come up with ANY for-profit healthcare insurance company that has ever experienced a loss. If one had their head buried in the sand deep enough, one might believe that it's because they're ALL just that efficient and well-managed.

This sounded ridiculous, so I looked into the last decade for ten big ones. Half them had posted losses at least once.

Aetna posted losses of $2.5 billion in 2002 and $279 million in 2001.

Humana posted a loss of $382 million in 1999.

Cigna posted a loss of $398 million in 2002.

Amerigroup posted a loss of $50 million in 2008.

Centene posted losses of $9 million in 1999 and $43 million in 2006.

[Dr Mabuse]

Originally Posted by orangecrush

I just think our system would do better if people had more incentives to reduce costs than it would if it were Medicare+

You think?

Only problem is Obama and the Dems signed back room deals with the big three: Pharma, insurance, hospital corps, that guaranteed they wouldn't ask the three reasons why we have health care costs magnitudes greater than anyone on the planet to control, much less reduce costs in any way. Since insurance companies quite literally declared war on the sick and started dancing for Wall Street, their premiums have skyrocketed over the last 10 years. This bill does nothing about that because Obama and the Dems care FAR more about the lobbyists and re-election money than they care about the much-heralded 'change' bullshit they were spewing on the campaign trail. I mean every campaign, except for re-election, is about 'change', but the degree to which Obama in 2008(particularly) and the Dems in 2006 sold that bullshit was unprecedented IMO.

The normal bullshit trotted out like tort reform(amazing anyone would fall for it but they do, mostly along party lines), so-called 'defensive medicine', etc. are bullshit put out by the masters of information that do not even amount to a drop in the bucket combined. But they 'sell' to the ignorant and the ideologue alike.

Until we address those big three above, there will only be continued skyrocketing costs in the US. Costs skyrocketing for a health care system that already costs magnitudes more than anyone other on earth, and barely cracks the top 20 for actual results.

[kvrdave]

If the idea is just to extend our lifespan and quality of life (as the end result), it would be much simpler to simply require everyone to be either Mormon of Seventh Day Adventists. They live an average of 10 years longer than the rest of us. That's even better than all the other countries we tout as having such great lifespans.

[orangecrush]

Originally Posted by Dr Mabuse

The normal bullshit trotted out like tort reform(amazing anyone would fall for it but they do, mostly along party lines), so-called 'defensive medicine', etc. are bullshit put out by the masters of information that do not even amount to a drop in the bucket combined. But they 'sell' to the ignorant and the ideologue alike.

I don't know about others, but my true motivation for wanting some kind of tort reform is really just about sticking it to the lawyers. If I can sell it by claiming health cost benefits, so be it.