[HN Gopher] Leaked Scripps records reveal automated mark-ups for...
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Leaked Scripps records reveal automated mark-ups for hospital care
Author : mmastrac
Score : 76 points
Date : 2021-12-10 17:05 UTC (5 hours ago)
(HTM) web link (www.latimes.com)
(TXT) w3m dump (www.latimes.com)
| yborg wrote:
| I'm wondering what it will take to stop this, it's basically
| institutionalized loan sharking across a giant chunk of the
| economy critical to society. The entire market, from insurance
| companies to providers is falling over itself trying to out-gouge
| the consumer because there's no repercussions. And why aren't
| there startups out there coming to compete for this gigantic
| money pool by offering a mere 400% markup?
| tastyfreeze wrote:
| The normal market pricing feedback that is present in other
| markets is broken in medical markets. This is mostly because
| prices aren't known and the recipient of services often isn't
| directly the payer.
|
| Publishing prices so people can shop around like any other
| product is a good starting point. Hospitals do not have to
| compete on price because insurance covers it in most cases and
| in many places they have a local monopoly.
|
| Also the more people pay out of pocket for medical the more
| they care about what the price is.
| 908B64B197 wrote:
| > And why aren't there startups out there coming to compete for
| this gigantic money pool by offering a mere 400% markup? You
| are thinking like someone from an industry that went from a
| $5,543 (2020 dollars) Apple ][ in 1977 to a $999 MacBook Air in
| 2021. That's all thanks to solid engineering, innovation and a
| competitive landscape.
|
| Now, for anything touching healthcare, you'll have to deal with
| The Cartel. You are going to get every legal challenge thrown
| at you by every instance of government (and The Cartel itself)
| before you can even think of helping your first patient.
|
| You'll basically need a member of The Cartel to vouch for you,
| or train as one. To even get a chance of getting in, you need
| to accumulate at least 6 figures of debts and try to squeeze in
| one of the limited spots The Cartel opens up for new recruits.
| Then, after about a decade of classes (4 of them completely
| useless to you) and a few years of pointless hazing, you'll be
| given the privilege to price gouge yourself.
|
| By then, I'm not so sure you'll want to democratize access,
| sadly.
| willcipriano wrote:
| > And why aren't there startups out there coming to compete for
| this gigantic money pool by offering a mere 400% markup?
|
| Regulation. If you wanted to start a service that drives
| elderly patients to get their medicine, in some justictions you
| need the permission of the local ambulance company to make sure
| you don't cut into their profits. This process is called a
| certificate of need[0] and if you dont have one, you can't
| operate.
|
| It's like this with virtually everything medical related. If
| you try to compete they have ways to shut you down or stop you
| from starting all together.
|
| [0]https://www.usnews.com/news/best-
| states/articles/2021-07-09/...
|
| See also:
|
| Controlling the supply of doctors by limiting residency slots
| (https://www.aamc.org/news-insights/medical-school-
| enrollment...)
|
| Banning the reimportation of drugs produced in the US back from
| Canada at lower prices.
|
| Keeping older, safe, and well known drugs behind the counter
| (albuterol is a good example) to drive office visits and keep
| pharmacy revenues up. In other countries you can just buy many
| common drugs like that over the counter, cheaply.
| handrous wrote:
| The _single_ tool that AFAIK _every_ other advanced-economy
| state (OECD, if you like, but even some outside that) uses,
| despite all the different approaches in the wild, is: price
| controls.
|
| The more-free-market ones simply dictate prices on some things
| and services (with, for the more-free-market ones like
| Singapore, the _very real_ implicit threat of dictating even
| more of them if the market gets too greedy, with the less-free-
| market ones dictating more prices from the outset), and at the
| less-free-market end of the spectrum you have state monopsony
| (single-payer) or even direct state control of healthcare
| service providers, so the price controls are more _de facto_.
|
| I'm not aware of a _single_ system outside the US [EDIT: in a
| developed state, that is--I 've not looked into developing-
| world systems] that doesn't achieve their results with price
| controls. Even the relatively "free market" ones--again,
| Singapore is usually the prime example people bring out for
| that, and they use some price controls and a very credible
| threat of further intervention to make their system work. Given
| this, I don't have much hope of success for any reform that
| doesn't either directly set at least _some_ prices and threaten
| to set even more, or take even more control over price-setting
| (monopsony power, or nationalizing providers), given how
| _universal_ that element seems to be.
| SomewhatLikely wrote:
| Are there any examples where a public option is available at
| a reasonable price so any private practices have to compete
| on price?
| huitzitziltzin wrote:
| Not exactly as you may be thinking, but in many countries
| there is a parallel, private health care sector.
|
| The fact that patients have the choice to go to the public
| sector instead of the private likely keeps prices in the
| private sector down, but if there is literature on the
| extent and magnitude of those effects, I'm not familiar
| with it. Mexico is an example of such a country.
| handrous wrote:
| None that I'm aware of. My _guess_ would be that this is
| because if you do it poorly, it doesn 't help a damn thing,
| and if you do it well, it's just single-payer with extra
| steps. This is because to do it right you'd effectively
| _have to_ dictate that ~all providers take the public
| option insurance, and at that point you may as well do
| single-payer. Otherwise, there 's no reason to expect a
| public option, as in just another insurer that happens to
| be government-run, would be able to compete when providers
| can just refuse to take them unless they raise compensation
| to roughly match everyone else. At best it would apply only
| light downward pressure on prices.
|
| There _are_ some systems that have private (though,
| perhaps, non-profit only) insurance and a public insurer as
| a _kind of_ public option, as an insurer of last resort,
| but they place all kinds of restrictions on this, like
| standardizing basic-coverage plans and dictating that all
| insurers offer them, mandating that providers all accept
| these plans (including the government one) and so on, and
| often _still_ having other price controls on top of it.
| Closi wrote:
| What about the UK? Free at the point of service
| healthcare with relatively high quality and low cost
| private options eg via Bupa (when compared to the prices
| in the USA)
| handrous wrote:
| That's a private system _on top of_ a universal public
| one, no? It 's not an option as in "instead of private
| insurance, you can do this, but you can also forego this
| and use only private insurance". You have access to
| public care, period, and _can_ pay for _extra_ on top
| from the private system. Right?
| Jansen312 wrote:
| Same issue as college degree inflation. Clue : free money from
| Uncle Sam. At the end of the day, we all need to accept
| healthcare is never meant universal. It is limited just like a
| Gucci bag or a Ferrari. You can't make everyone have a Tesla,
| even if you try, the price will just go up. The only way to
| democratize the access it to build more and not to give more
| free money. If government build more hospitals, finance tons of
| MDs graduate, conduct all the pharmaceutical researches,
| hospital bills will reduce significantly. But alas, we all want
| coverage. We all believe every Tom Dick and Harry or Jane Jill
| or Jenny should be guaranteed with healthcare access. See Barry
| nonsense Barrycare. We all need to learn from handphone market.
| There will always be many tiers models to fit different
| budgets. We shouldn't restrict doctors and care only within
| USA. Let other countries healthcare acceptable to USA insurance
| and medicaid claims. If every handset is made in USA, sure
| Motorola will still be the Apple iPhone today. See when China
| able to crank out segway and phones cheaper, many gets to
| enjoyed it.
| _jal wrote:
| > I'm wondering what it will take to stop this
|
| Single payer.
| tastyfreeze wrote:
| Single payer is not really a solution to the healthcare cost
| problem. All it does is give government more power that it
| doesn't have Constitional authorization to posses.
|
| A real solution to healthcare cost is making healthcare a
| functioning market where the buyer knows prices before they
| purchase.
| paxys wrote:
| A free market solution will never work in healthcare
| because neither side has the ability to say no and walk
| away when they can't come to an agreement on price.
|
| A consumer cannot price shop and delay an appointment or
| procedure when it is a matter of life and death.
|
| A hospital or insurance company cannot say no to someone
| who they are 100% sure will never be able to pay the bill.
| tastyfreeze wrote:
| That is what insurance is supposed to be for. Medical
| insurance should be more like home or auto insurance. My
| home and auto policies do not cover maintenance and
| improvement but they do cover rare catastrophic events.
| My medical insurance covers every damn thing that has to
| do with medicine. If I go to the doctor for an annual
| check up there is no reason that insurance should be
| involved as that is a regular and elective cost. If I
| break my arm that is unexpected and probably costly so I
| would have insurance to cover something like that.
|
| Insurance is for uncommon events that you have little to
| no control over. The policy you choose should reflect how
| you want to mitigate your own risk of uncommon events
| happening.
| paxys wrote:
| Insurance companies actually _want_ to pay for your
| regular, non-emergency medical costs because it is way
| cheaper for them to do so vs letting conditions go
| undetected and then paying orders of magnitudes more for
| surgeries, prescriptions and expert visits. Your annual
| checkup visits aren 't what is causing ballooning
| healthcare costs, but actually lowering them.
| handrous wrote:
| It's possible that would work, but I'd prefer to try a
| system that's successfully in use in _any_ other advanced
| economy, than to gamble on that. Meanwhile, if you can
| convince some other country to try "be _very_ free market
| " as an experiment for their healthcare system, please do
| so, I'd love to see the results.
| jatone wrote:
| we have that today. law was passed last year. its not going
| to do shit.
| tastyfreeze wrote:
| Are you talking about the CMS Price Transparency rule?
| That went into effect on January 1st this year. Is your
| hospital compliant yet? Mine isnt. I can request a quote
| for "shoppable services". They do not have a machine
| readable format listing of all their "standard charges"
| and they do not have a customer readable format listing
| of prices for "shoppable services".
|
| Rule changes like this take time to be implemented and
| effective. You cant very well expect current practices to
| change when effectively very little has changed in price
| transparency yet.
| jatone wrote:
| indeed I am, and yes I know.
|
| I'm asserting even if it was implemented fully it won't
| do shit. I have insurance why would I give a shit about
| the prices? my employer pays the majority of the costs.
| its only going to incentives the uninsured to go shopping
| and they're a very small market.
|
| thats precisely the problem. lack of choices in the
| insurance market where the incentives are not aligned.
| jedberg wrote:
| Most countries solve this by requiring hospitals to be non-
| profits and making insurance non-existent or also non-profit.
| ceejayoz wrote:
| Non-profit doesn't mean you can't _make_ a profit, just that
| you can 't distribute it to shareholders.
|
| Big salaries, perks, and bonuses to executives is just fine.
| jedberg wrote:
| They usually tie it to caps on executive salary and bonus,
| but even without it's still better than for-profit.
| whatthesmack wrote:
| Why is it better? Non-profits don't have the efficiency
| incentive that for-profits do, as far as I understand it.
| I've read a few things that indicate non-profit hospitals
| are full of fiscal bloat, because there's no incentive to
| act otherwise. On mobile now, but can search for a few
| sources.
| KoftaBob wrote:
| Around 75% of hospitals in the US are actually non-profit.
|
| Source: https://www.kff.org/other/state-indicator/hospitals-
| by-owner...
|
| All this ends up meaning is that any revenue above their
| expenses is plowed into hiring more and more administrative
| staff and building new facilities.
| jedberg wrote:
| I didn't say it would solve all the problems, but it would
| help.
| KoftaBob wrote:
| Agreed, adding a profit motive on top of that only makes
| it worse.
| tyoma wrote:
| Scripps, the hospital in question, is already a non-profit.
| Their domain even ends in .org! They also have posters asking
| for donations, and will send mailers asking for donations as
| well.
| jdminhbg wrote:
| More than half of US hospitals are non-profits, and Obamacare
| capped the profit % for insurance companies.
| jedberg wrote:
| Yep, it was a start. But the insurance companies have
| figured out ways around the caps.
| handrous wrote:
| I've noticed that an awful lot of insurers around here
| seem to always be crying about "losing money" on
| seemingly every plan, now, and so demanding huge rate
| hikes every year. I don't believe that they're actually
| _that_ terrible at their jobs--not the parts that
| directly relate to P &L, anyway--so I have to assume this
| is some part of scam they've worked out.
| poidos wrote:
| Either socialized or nationalized medicine. Removing the
| insurance companies entirely removes the price-gouging they do
| from the equation. On the non-insurance front, every hospital
| and care provider is then required to either
|
| - negotiate with the government on prices, or
|
| - work for the government, charging their rates.
| dontcare007 wrote:
| And then waste and graft moves from a semi-accountable
| company to a group that has the use of force to enforce their
| policies. No thanks.
| jatone wrote:
| the fact you think insurance companies are accountable is
| laughable. last I checked I never could decide on what
| insurance provider my employer offered.
|
| I see no difference between private insurance and
| government run except the government is constantly
| lambasted for overspending and medicare seems to have the
| lowest operating costs and payouts to healthcare providers.
|
| which seems to be the exact metric you want.
|
| edit: just move to a public option system and watch shit
| hit the fan in the market.
| handrous wrote:
| > I see no difference between private insurance and
| government run except the government is constantly
| lambasted for overspending and medicare seems to have the
| lowest operating costs and payouts to healthcare
| providers.
|
| Contrary to popular understanding, relatively low
| (sometimes _impressively_ low) overhead & even fraud
| rates is the _norm_ for US government social programs.
| This is one case where pop-culture "common knowledge"
| diverges wildly from reality.
| jatone wrote:
| Indeed!
| throwaway0a5e wrote:
| >the fact you think insurance companies are accountable
| is laughable.
|
| Accountable is obviously relative.
|
| BigCo at least wants one thing you know about, money, and
| that makes them far less capricious and far easier to
| deal with than government where you don't know any of the
| incentives that the people who (with several layers of
| indirection) set the KPIs for the person you are actually
| dealing with.
|
| As evil as they are I'll take Comcast over some random
| state org any day.
|
| Having a public option as a backstop would probably be
| good but I don't think I want a public option that covers
| routine stuff, GP visits, a broken bone. Stuff with a
| well bounded upper limit like that tends to be handled
| well by private insurance so long as there's competition
| (see auto insurance for example).
| jatone wrote:
| then you're ideological driven instead of results driven.
| user1980 wrote:
| I live in Saskatoon, Saskatchewan, Canada. If I want to find
| a family doctor, there is a list of 3 clinics with doctors
| taking patients, in a metro area of 325,000. Older people
| have "the good doctors" and those doctors aren't taking on
| new patients.
|
| Waiting lists for specialists are ridiculous, unless it's
| something extremely urgent. It quickly becomes about "who you
| know" and queues can be jumped if you have the inside track.
|
| I've never been encouraged or "nudged" to get a physical or
| even blood work done. Quite frankly, the system is under so
| much strain that getting everyone a physical would push it
| over the brink. So they mandate them for commercial drivers
| and other high-risk occupations, and everyone else just goes
| to medi-clinics and sees a walk-in doctor. Zero continuity of
| care.
|
| Canada is great at treating the dying, terrible at treating
| the healthy.
|
| I'm self-employed. Dental, prescription drugs, glasses,
| mental health: this is all out of pocket.
|
| My impression is that if you have a reasonably good job in
| the United States, you have access to reasonable health care.
| Is that a fair assessment?
| egberts1 wrote:
| Hospitals and specialists should be made to post prices of their
| services ... by law.
| drdec wrote:
| That is the law in the US as of January of 2021:
|
| https://www.cms.gov/hospital-price-transparency
| KoftaBob wrote:
| They are, as of January 2021. The effects of that will take
| some time to be seen in pricing.
| 0xcde4c3db wrote:
| Even if you have the list, there's not necessarily any way to
| be sure in advance which price(s) you'll end up paying. The
| whole system is built around an incomprehensible fog of
| "discounts" and idiosyncratic distinctions among similar
| procedures.
| jedberg wrote:
| We have that law in California. Enforcement is lax. Sometimes
| it's a single piece of paper up on a wall in a hidden corner.
| Sometimes they don't have it at all.
|
| But at the end of the day, it's not like you're price shopping
| when you're having a heart attack. You're going to the closest
| hospital and sorting out the cost later... which is exactly
| what they are counting on.
| xyzzy21 wrote:
| Publish ALL prices prior to admission.
|
| There are hospitals overseas who precisely publish their prices
| for standard procedures. This is why pre-COVID I would travel
| overseas for any medical procedures that could be scheduled
| ahead of time: it was a known, low variance expected cost.
|
| There is no reason not to public pricing short of fraud,
| conspiracy and lack of ethics. We are already seeing exactly
| how much ethics/morals much of the pharma, health care and
| public health of USA actually have (i.e. next to NONE).
| jl2718 wrote:
| 1. End all insurance mandates
|
| 2. Allow fee-for-service Medicare.
| kingsloi wrote:
| billable amount = (pain_and_suffering / 2) + 7
| servytor wrote:
| Colleges are the exact same - once it becomes standard for an
| intermediary to handle the bill, the costs skyrocket. From the
| government giving anybody who goes to college a loan, means that
| colleges can charge insane fees despite no change, and hospitals
| charge insane fees because it is standard to gouge insurance.
| kevin_thibedeau wrote:
| Part of the problem is the loss of mutual insurance which makes
| executives accountable to their members and forces profit
| sharing.
| ethbr0 wrote:
| > _I started asking questions," the nurse said. "I was told that
| if we didn't mark things up like this, insurance companies
| wouldn't give us what we want."_
|
| > _Healthcare providers routinely ignore the actual cost of
| treatment when calculating bills and instead cook up nonsensical
| figures to push reimbursement from insurers higher._
|
| This is the real story of health care, in a nutshell.
|
| Providers say "A procedure costs $100." Insurers say "Great,
| we'll reimburse you $50 for it, or you won't be in network."
| Providers say "But it actually costs $100." Insurers say "Fine,
| but cut us a deal in exchange for our business, and charge us
| $50." They hammer out a contract that specifies $55 for that
| procedure.
|
| On the next procedure, which costs $200, the providers (and their
| facility) stops to think. "Wait, insurance is going to ask for a
| substantial haircut on whatever number we give them." So
| providers say "This procedure costs $400." Insurance says "Fine,
| we'll reimburse you $200." Providers say "Oh no. Fine, we'll take
| it."
|
| Then a few years later insurance analysts get around to noticing
| relative cost differences, and the entire dance starts over
| again.
|
| The fundamental problems with US health care are (1) the lack of
| end-user (patient) visibility into costs _before_ undertaking a
| procedure, (2) opaque insurance-facility contracts, & (3) the
| bullshit dance between facilities, middle people, and insurance
| companies that end up adding confusion, delay, and costs to what
| would otherwise be simpler transactions.
| mjevans wrote:
| Which is why I try to vote for politicians that support any
| kind of single payer / medicare for all / etc healthcare and
| was so very disappointed with what Obamacare became: just
| payouts to the established anti-consumer groups as usual.
| jimbob45 wrote:
| I don't understand your point on #1. What good is visibility
| going to do me? I have only so many hospitals reasonably
| distant from me in-network such that competition isn't likely
| to substantially alter my price, I would think.
| setgree wrote:
| This is a minor quibble, but this sentence:
|
| >Scripps' automated system took the actual cost of sutures,
| imposed an apparently preset 675% markup and produced a billed
| amount that was orders of magnitude higher than the true price.
|
| was jolting for me as a reader -- going from $19.30 to $149.58 is
| an increase of around _one_ order of magnitude rather than many.
| tastyfreeze wrote:
| This is what happens when the buyer doesn't care what the price
| is because its not their money and the seller doesn't publish
| prices to allow comparison. Insurance companies only care if a
| price is outside of "normal" as they can just increase premiums
| as hospitals push "normal" continually higher.
|
| Hospitals make ridiculous profit. Insurance companies make
| ridiculous profit. Neither of them care at all what the real
| customer gets charged.
|
| See also Federally guaranteed student loans
| evergrande wrote:
| This chart speaks volumes.
|
| https://www.investors.com/wp-content/uploads/2018/03/CPIChar...
| nebula8804 wrote:
| I've seen this chart blasted around the mainstream media and
| I feel it is sort of cheating. The categories below the 0%
| line: Cellphone Service, Software, Toys and TVs all benefited
| mainly from one miracle innovation: Moore's Law. Other than
| that, have they really done anything else innovative to keep
| prices that low? If you eliminate anything that mainly
| benefited from Moore's law then you can derive a very
| different picture from the chart.
|
| I guess we should be thankful to Moore's law and figure out
| how to apply it to Childcare, College, and hospital services?
| I guess thats where Elon Musks's robot comes in to play. It
| can teach you skills to get a job, take care of your kids,
| and then perform your surgery. Problem solved! :)
| KoftaBob wrote:
| > Hospitals make ridiculous profit.
|
| What's interesting about this is that around 75% of hospitals
| in the US are actually _non-profit_.
|
| Source: https://www.kff.org/other/state-indicator/hospitals-by-
| owner...
|
| All this ends up meaning is that any revenue above their
| expenses is plowed into hiring more and more administrative
| staff and building new facilities.
| huitzitziltzin wrote:
| I'm a health economist who works on hospitals. There is a
| long-standing question in our literature about whether non
| profit and for profit hospitals actually _act_ differently.
| My sense has always been no.
|
| You also leave out one important place for "extra" money to
| go: salaries within the hospital.
| seibelj wrote:
| There are many who work in non-profits with high 6 or 7
| figure salaries. Seems like profit to me!
|
| Back in 2015 the president of Boston University raked in $2.5
| million https://www.bostonmagazine.com/education/2017/12/11/b
| oston-u...
| KoftaBob wrote:
| That's only 50 students worth of tuition for that year, or
| 0.3% of tuition brought in that year.
|
| While $2.5M is obviously a lot of money, it's a drop in the
| bucket in terms of how much the university brought in. For
| universities and hospitals, it's not the high salaries of a
| few execs, it's the massive amounts of administrative
| staff.
|
| For the larger hospital systems, several thousand admin
| staff making 60-70k+ adds up to waaaaay more than the fat
| paychecks that a dozen execs make.
|
| It's basically a snowball effect. Execs get bonuses for
| bringing in more revenue, but it's a non-profit so they
| have to spend it somewhere, so they expand admin and build
| facilities, rinse repeat.
| lrem wrote:
| Naive question: what if instead admin they would expand
| actual medical staff?
| tastyfreeze wrote:
| That facility may not need more medical staff. Jobs can
| always be created for administrative purposes. Have any
| tasks you dont like doing that you have to do with some
| regularity? Higher somebody to be in charge of that task.
| lrem wrote:
| I'm not familiar with the US hospitals... But pretty much
| everywhere else I've seen the doctors and nurses being
| seriously overworked. Is this different on the other side
| of the pond?
| tyoma wrote:
| The hospital system in the article (Scripps), is indeed a
| non-profit. They even have posters and mailers asking for
| donations.
| tastyfreeze wrote:
| Non-profit does not mean that hospitals aren't out to make
| money. It only means there is some restriction on where the
| extra money goes.
| colechristensen wrote:
| All non-profit means is money doesn't go to investors. And
| considering tax and fringe benefits going to "donors" even
| that is somewhat less true.
| WillPostForFood wrote:
| FWIW, the institution in the article, Scripps Health, is a non-
| profit. Would be interesting to see where the money is going.
| throwaway0a5e wrote:
| Hospitals are routinely nonprofit orgs. I assume scripps
| overpays everyone and pays for crap it just doesn't need like
| hospitals do.
| handrous wrote:
| > This is what happens when the buyer doesn't care what the
| price is because its not their money and the seller doesn't
| publish prices to allow comparison.
|
| The norm in most systems (in developed states, anyway) is that
| the buyer doesn't care what the price is, to _at least_ the
| same degree that they don 't in ours. Yet they're _all_ much
| cheaper than our system.
| mikem170 wrote:
| Most of those other systems have price controls for
| everything, like Medicare does in the U.S.
|
| The U.S. is different because we allow corporations to
| lobby/bribe/buy politicians, which most other developed
| countries consider to be corruption.
|
| So we have a health care system optimized for profits, not
| people.
| handrous wrote:
| Bingo, see my post elsewhere in this thread :-)
|
| I'm no expert but have been reading about this for a couple
| decades now, and the consistent element in _every_ non-US
| system in developed countries, despite a vast variety of
| approaches, is indeed price controls, either explicit or
| _de facto_. I 'm highly skeptical of any reform attempt in
| the US that doesn't have that as a central element, due to,
| you know, _gestures at the rest of the world_.
| derekjdanserl wrote:
| That's right. But the employer-dependent health insurance
| arrangement in the U.S. was implemented as an alternative to
| the various political dynamics that regulate most countries'
| healthcare systems and it has successfully done so.
|
| The problem, in other words, is that a truly free-market
| healthcare system would be politically infeasible in a major
| first-world nation. So instead of a public healthcare system
| that would provide minimal healthcare services to all
| citizens, they tied it to employment, effectively moving it
| from the consumer market to the labor market. So this
| arrangement, like most neoliberal policies including
| Obamacare, has served merely to buy more time for the ruling
| class. And worst of all it has worked.
| ethbr0 wrote:
| > _Hospitals make ridiculous profit._
|
| "It depends."
|
| Non-trauma hospitals in affluent areas that perform lots of
| elective procedures make a lot of profit.
|
| Trauma centers in less-affluent, usually urban or rural, areas
| that deliver emergency care almost always run at a loss, and
| are subsidized by city / state / federal funds to maintain
| capability.
| derekjdanserl wrote:
| Whether it's hospitals, hosipital owners, doctors, or other
| healthcare industry benefactors, someone is making a killing
| beyond just the insurance companies. Ballooning
| administration is not only a cause but a symptom, which is
| why free market solutions can't overcome the problem.
| Establishing new healthcare institutions will depend on the
| existing healthcare industry, which will expect the same
| profits or it won't cooperate. There is no way around the
| fact that free-market healthcare is just deeply immoral and
| inhumane.
| tastyfreeze wrote:
| Your entire argument is based on the assumption that
| healthcare is a free-market which it is obviously not. The
| mechanisms of price discovery are not present to all
| players in the market. When there is an unbalance in
| information in any market it will always be detrimental to
| the player with less information. The way to fix the
| problem is to create a free-market.
| lotsofpulp wrote:
| There never will be a free market due to inability to
| negotiate prices and obtain quotes.
|
| A person who had a stroke is not going to be evaluating
| offers from various surgeons. Nor are 99% of people going
| to know what healthcare they need or don't need.
|
| That is the service a managed care organization provided
| (aka insurance company).
| staircasebug wrote:
| US healthcare is most definitely not free market.
| afsafsaf wrote:
| Shouldn't the insurance company care because if they can reduce
| their premiums, they can be more competitive for
| employers/purchasers? I don't understand why the insurance
| company isn't cost driven.
| mox1 wrote:
| Have you ever "shopped around" for health insurance? Maybe
| ACA people do, but amongst 2 or 3 giant companies on the
| exchange..whose prices, features, benefits, etc. are
| basically the same.
|
| Further, most bigger companies self-insure, and only use the
| insurance company to provide services. So F100 company
| partners with Blue Cross Blue Shield just for billing,
| administration of the plan, etc. What does BCBS care how much
| surgery costs? They are getting Admin fees the same whether
| its $5,00 or $10,000. Does a F100 employer really have the
| time and energy to question whats going on? They just look at
| the cost last year, raise the price for their employees by
| %XY and march forward.
|
| Even further, health insurance is incredibly regulated, on a
| state level. If you have a good idea to "disrupt" the
| industry, its such a slog to get anything done. Your best bet
| is to partner with an existing insurance company and go from
| there.
| pmalynin wrote:
| Insurance companies are require to put a certain % of the
| premiums towards actual healthcare. In other words
| administrative fees (read profit) is capped as a % of the
| premium. The higher the premium the higher the profit.
| SomewhatLikely wrote:
| These ridiculous markups existed before those caps imposed
| by the ACA.
| SkittyDog wrote:
| The ACA did not impose those caps, in the first place. It
| merely standardized them.
|
| State insurance laws have mandated the same kind of caps
| for decades... I believe they date back to around WWII,
| but I don't know for certain.
| huitzitziltzin wrote:
| Administrative fees =/= "profit". That is wrong.
|
| Administrative fees _include_ profit, but also salaries, IT
| expenses, whatever other costs it takes to _actually run_
| an insurer.
| quinnjh wrote:
| Medical costs being high mean that you have to buy the
| insurance
| SkittyDog wrote:
| Another poster mentioned this, bur I think it's worth talking
| about in more detail, because it's at the heart if exactly
| what's broken about US health care.
|
| Every US state has laws that prohibit insurance companies
| from collecting "too much" profit from the premiums they
| charge their customers. In most states, the limit is given as
| a percentage of pure profit. So insurers set their premiums
| based on their expected payout costs plus operating expenses,
| and usually make premium adjustments on an annual basis.
|
| (That's why most US drivers received a bunch of rebates from
| our auto insurers, early in the COVID pandemic. The sudden
| unexpected drop in accident rates drastically reduced the
| insurers payout costs. They were required by law to return
| the excess.)
|
| The intended purpose of these laws was to protect consumers
| from predatory insurance companies. But in modern practice,
| with basically zero effective cost controls on medicine, it's
| created a perverse incentive: Rising healthcare costs are the
| easiest opportunity for health insurers to increase their
| absolute profits... All they have to do is sit back and let
| health care providers keep raising their prices.
|
| But:
|
| * the costs are passed only indirectly to the consumers who
| ultimately pay
|
| * the market for health care is so terribly distorted
|
| * health care demand is highly inelastic
|
| So normal market mechanisms (like price signaling) aren't
| very effective at containing the rise in costs.
| [deleted]
| tyoma wrote:
| I am a Scripps customer. Their prices are not different than any
| other healthcare system in the area. They all do this; Scripps
| just made it more obvious how prices are actually set.
|
| And since this has been brought up in the thread: Scripps is
| already a non-profit! Their domain name ends in .org. They
| routinely ask for donations.
| efitz wrote:
| As with anyone who has a soul and a conscience, im shocked by
| health care costs.
|
| A lot of people say this is a failure of capitalism. It is
| precisely the opposite- it's regulatory capture. Healthcare and
| insurance are among the most highly regulated industries in the
| US. All that regulation has had decades to fix the problem and
| hasn't; it's caused the creation of workarounds like "charge
| masters" and "pharmacy benefit managers" that make prices more
| opaque.
|
| Why do we even allow negotiated price for insurance? Sounds like
| antitrust/price fixing/collusion to me? Why doesn't each health
| care provider publish their prices and the insurer publishes what
| they'll pay and the patient is responsible for the difference?
| olliej wrote:
| I'm mostly surprised that nurses and doctors were able to see the
| mark ups being applied. I'm sure that the next update will "fix"
| that.
|
| How these markups don't run afoul of price gouging laws is beyond
| me :-/
| huitzitziltzin wrote:
| This is an infuriating but not surprising read. The only
| surprising thing to me is to see the number written down. (And
| that some part of the system was available to a nurse to see!)
|
| I'm a health economist and much of my research is on hospitals.
| As much as everyone loves to complain about drug companies and
| insurers as being responsible for high US health care costs, that
| _is not_ where the money goes. The money goes to doctors and to
| hospitals. (Specifically: about half of all national health
| spending to those two groups.)
|
| If you want to save money on health care, you need to talk about
| paying less to doctors and to hospitals. If you don't want to pay
| less money to those two sets of entities, you aren't going to
| save much money. That's all there is to it.
|
| Yes, we can do better by spending less on drugs, but it's a small
| amount compared to the gigantic sums which go to doctors and to
| hospitals. (Specifically: _all_ drug spending is about ten
| percent of national health spending.) Yes, we can do better by
| reducing the administrative burden, but that slice of the pie is
| less than 10%. (And you will never have 0 admin expenses.) The
| administrative burden of health insurance is even lower than 10%.
|
| So... go ahead and share your ideas for paying doctors and
| hospitals less, because otherwise you're talking about stuff
| which doesn't amount to much!
| mschuster91 wrote:
| > The money goes to doctors and to hospitals.
|
| For doctors, that pay is well deserved given the exorbitant
| student loans that doctors carry, and the ridiculous shift
| length and other work related issues.
|
| For hospitals? Here's the real deal where costs can be saved -
| 25% of hospital expenses is administration expenses [1], and 8%
| is profit margin [2].
|
| Convert hospitals to non-profit operations owned by a single-
| payer insurance and immediately save a _lot_ of costs across
| the entire board.
|
| [1] https://www.commonwealthfund.org/publications/journal-
| articl...
|
| [2]: https://www.americanprogress.org/article/high-price-
| hospital...
| munk-a wrote:
| Having seen the working conditions of testers in the video
| game industry I can say that:
|
| > For doctors, that pay is well deserved given the exorbitant
| student loans that doctors carry, and the ridiculous shift
| length and other work related issues.
|
| Is pure BS. Many professions end up carrying student loan
| repayment for decades and that isn't usually used as an
| excuse for increased pay - additionally there are plenty of
| professions (and folks working two jobs) that end up putting
| in more hours than doctors. These costs aren't describable
| using either of those causes.
|
| Additionally, most hospitals are already technically non-
| profit organizations - it's just that administrators can end
| up having purely ridiculous take-homes. A single payer system
| probably is the solution but mostly because of the price
| setting and ease of billing - if you compare Canada to the US
| you'll notice that the Board of Physicians sets procedure and
| drug pricing provincially rather than being left up to a
| patchwork of random private corporations.
| huitzitziltzin wrote:
| >> For doctors, that pay is well deserved given the
| exorbitant student loans that doctors carry, and the
| ridiculous shift length and other work related issues.
|
| Disagree on many, many counts.
|
| - do you know many specialists? Ridiculous hours are not part
| of the picture post-residency!
|
| - deserved why? On the basis of what? More than a taxi driver
| who works long hours? A convenience store worker who works
| long hours?
|
| - student loans are not that hard to pay off at US (medical)
| salaries! There are surgical specialities where the average
| pay is north of $500k. Family medicine and pediatrics make a
| lot less.
|
| >> Convert hospitals to non-profit operations owned by a
| single-payer insurance and immediately save a lot of costs
| across the entire board
|
| - converting hospitals to non profits isn't going to do much
| because most are already not for profit.
|
| - you save money with single payer (ideally) by paying lower
| prices... which is my original point. There is administrative
| bloat and burden in the system but it's on the order of 10%
| of spending, not 40%.
|
| And, just to be clear, you _have to administer_ hospitals in
| single payer too so you don't get rid of those costs
| entirely.
|
| I can support single payer, but I support it to _pay lower
| prices_ to doctors and hospitals (and pharma, but as I noted
| above that's not a big slice of the pie either).
| YossarianFrPrez wrote:
| Fascinating. I have some questions I'm hoping you can answer.
| Can you speak to the narrative of administrative bloat in US
| hospitals? Are doctors paid relatively less in other countries?
| And is there any chance that the high pay is needed to counter-
| act overly stressful working conditions in the US (vs., say,
| the UK's NHS?)
|
| I'm also curious about doctors' personal expenses. If most of
| their salary is going towards rent or homeownership, short of
| situating a hospital on something like a kibbutz... maybe there
| is some sort of rent subsidy -- or tax break for landlords that
| give a 10% rent discount / for banks that give a medical
| professionals low interest home loans -- that could be enacted.
| It could allow doctor's effective salaries to stay the same,
| but medical prices to drop?
|
| I'm afraid you are going to say that doctor's biggest personal
| expense is student loans for medical school! If medical-school-
| debt were to be wiped out, do you know how much salaries could
| drop in terms of objective price without changing doctor's
| effective income?
| stonemetal12 wrote:
| The relative difference in pay between US and UK docs is
| 3x(in favor of US docs). In most cities across the US Drs
| live in the wealthiest neighborhoods, they don't need housing
| help. The main problem in the US is headcount, there just
| aren't enough Drs to go around, as such salaries are driven
| sky high.
| YossarianFrPrez wrote:
| Ah, interesting. Is this related to the fact that there was
| a cap on the number of funded residencies? [0] Or maybe
| there was some other cap in the graduate medical education
| system between the '70s and the 90's... I have a vague
| recollection of reading something about this.
|
| [0] https://www.ucop.edu/federal-governmental-
| relations/_files/f...
| huitzitziltzin wrote:
| - Cross-country administrative bloat is not a literature i
| know, if it even exists. As a complicating factor, I don't
| know if we have too many or they have too few. Probably us
| too many, but relative to what exactly? That's hard to say.
|
| - doctors in the US are paid relatively more, generally by A
| LOT, but the only data I know about this is old. US doctors
| are not that enthused about hearing they should be paid less.
|
| - as another commenter notes, we have fewer doctors and fewer
| hospital beds than most other OECD countries.
|
| - related: despite what you may hear, our utilization is
| lower than most other oecd countries. (At least in the
| following dimensions: hospital visits are less frequent and
| are shorter.)
|
| - I don't know of good data about doctors' personal expenses.
| But there is a paper from a few years ago which looked at
| labor department data and found that a decent fraction of the
| top 1% of the income distribution in the US was made up of
| doctors. I may be able to find that reference and the fact
| I'm citing may be misremembered.
|
| - sure, doctors do have high medical school expenses and debt
| here relative to other countries but for anyone who is not in
| primary care, it's not going to take that long to retire the
| debt. There are multiple specialties which pay north of
| $400,000 per year.
|
| - I do not think doctors' salaries are related in a
| meaningful way to their debt. Which is to say: if you
| canceled all medical school debt tomorrow, prices for
| physician services would decline by about 0%. Those costs are
| sunk. They are not going to have a large effect on prices.
| YossarianFrPrez wrote:
| Great, thanks for the detailed response. Makes me wonder
| about if the supply of doctors in the US been artificially
| constrained to inflate salaries.
| huitzitziltzin wrote:
| Ooh I love easy questions! The answer to this one is yes!
|
| You can thank the American Medical Association.
| tkahnoski wrote:
| Another factor is not all doctor salaries are the same.
| Anesthesiologist 400k, Family practice or OB/GYN 200k.
|
| Anesthesiologist is buying a lamborghini, the family practice
| person needs a few years before they can entertain buying a
| house.
| tastyfreeze wrote:
| Any idea why there aren't more people training to be
| anesthesiologists? A salary like that is a strong incentive
| for people to enter the professions. Or is this more of a
| training lag problem where it takes 12-14 years for a labor
| shortage signal like high salary to start being satisfied
| by new anesthesiologists?
| cyberge99 wrote:
| If I'm not mistaken they pay huge malpractice insurance
| amounts because a misdiagnosed dosage of a lethal
| chemical (sedative, anesthesia) can be, well, lethal.
| conanbatt wrote:
| Skill markets are not very efficient: not all developers
| jump to blockchain or ML for example. Also there tends to
| be limits on how many slots for residences and practices
| there are for different specialties: the system is
| purposefully capped to make sure that there aren't too
| many doctors.
|
| The way to skip all of this is massive de-reg.
| huitzitziltzin wrote:
| Generally residency spots are limited. This creates a
| scarcity which keeps prices high.
|
| I doubt the claim of the commenter below who argues that
| it is malpractice insurance. There are by now plenty of
| "tort reform" states where malpractice payouts are
| capped. I would be very surprised if anesthesiology
| prices are any lower in those states.
| conanbatt wrote:
| > Can you speak to the narrative of administrative bloat in
| US hospitals?
|
| Admin bloat is a consequence of having too few doctors, and
| also legal requirements on how visits have to be handled in
| the US. For each medical visit you get at least 10~15m of
| recording the visit. A doctor without any help would spend
| around half the time talking to a patient, and half the time
| filling out charts for insurance and legal requirements.
|
| Thus to make money you need to delegate all those tasks as
| much as possible, and you get to a point where some hospitals
| even offer a full medical assistant per provider. To solve
| this you need to have way more doctors, and a lot less
| medical liability from a legal standpoint. For example, you
| cant have paper charts in the US, which is standard in many
| other first world countries.
|
| Billing is also a very expensive source of admin work. You
| have to have a perfect pipeline for billing to have high
| collections, then you have issues collecting the money months
| after that is settled, etc etc. Many ways to solve this one,
| but partially solved by moving a lot of expenditures to cash-
| based payment. You can save all of this in a cash-based
| system. Alternatively you could have competition in the
| insurance market, but although that could improve things, in
| the end, you still need to write medical and administrative
| work to get paid. This problem also exists in many other
| countries.
|
| > Are doctors paid relatively less in other countries?
|
| The Gross income of physicians in the US is surely the
| highest in the world. But gross is gross. At those levels
| taxation approaches 50%, and medical education can cost half
| a million dollars. Its a perverse system where you pay a lot
| to a ticket to earn a lot, but you get collected all the way
| to the bank. And if you dont make it, you fail really hard.
| Primary care physicians are the lowest paid in the us and
| have an abnormally high suicide rate.
|
| > And is there any chance that the high pay is needed to
| counter-act overly stressful working conditions in the US
| (vs., say, the UK's NHS?)
|
| High pay is a simple result of too few physicians. But what
| goes to physicians directly is a smaller part of spending:
| only about 10% of spending goes directly to physicians. You
| can make it better, but I think its likely they want better
| working conditions over money, its just not an option in this
| market structure. You cant operate part time, or with 30min
| appointments, without charging patients above insurance
| levels. (example, OneMedical, Concierge medicine, parsley,
| etc).
|
| > I'm also curious about doctors' personal expenses. If most
| of their salary is going towards rent or homeownership, short
| of situating a hospital on something like a kibbutz... maybe
| there is some sort of rent subsidy -- or tax break for
| landlords that give a 10% rent discount / for banks that give
| a medical professionals low interest home loans -- that could
| be enacted. It could allow doctor's effective salaries to
| stay the same, but medical prices to drop?
|
| This market structure needs less rules, not more rules. I
| have NEVER seen a market so captured as this one, and its
| captured by everyone in some way. Every single actor in this
| market is using government to get something from someone
| else, including patients, insurance takers, physicians,
| admin, pharma, gov. Literally everyone.
|
| > I'm afraid you are going to say that doctor's biggest
| personal expense is student loans for medical school! If
| medical-school-debt were to be wiped out, do you know how
| much salaries could drop in terms of objective price without
| changing doctor's effective income?
|
| Causal relationship is backwards here. Salaries are not high
| because medical debt is high. Salaries are high because there
| are too few doctors, because it is too expensive to get an
| education for it. If you wipe out medical debt, you are
| assisting the ones that made it over, but not all the ones
| that could not make it in the first place. To reduce the cost
| of education you need to do a few things:
|
| 1- eliminate federal funding for education, that makes it
| only "approved" universities be able to provide limited
| slots.
|
| 2- Eliminate or reduce the cost of licensing. In the us you
| need a license _per state_ to practice medicine, and it is
| very stringent. If it were handled like a legal bar exam
| instead, you would put significant pressure in the college
| system while also allowing for independent education to
| ocurr.
|
| 3- Allow medical degrees from other countries to practice in
| the US. This would leave the option for doctors to study
| abroad for nearly free and come back and practice.
| conanbatt wrote:
| Hospitals are 40% of the NH spending so I would even not look
| at doctors that way.
|
| The market structure is such that there are very few doctors,
| so you need to do your operations in a way that doctors spend
| as little as possible with patients, and you delegate as much
| to assistants and administrative chores. With a massive supply
| shock on doctors you would not only lower wages for doctors,
| you would also lower admin costs.
|
| One caveat, even though doctors wages are very high, they are
| also rent-captured by universities that charge mid six-digits
| for an education and medical insurance, and certifications that
| are burdensome and expensive. I remember medical malpractice
| insurance going to several thousand a month for OBGYN. There is
| a reason why clinical doctors have an abnormally high suicide
| rate in the US.
|
| Then hospitals get massive fed spending and money, plus often
| local protections that mean you cant open competing hospitals.
| In the book " The Social Transformation of American Medicine"
| they talk a lot about how hospitals rent-seeking behavior is to
| turn themselves as a non-profit, and then ask for federal
| funding and getting that denied to for-profit hospitals,
| effectively capping the amount of hospitals you can open.
|
| The WHOLE market structure needs a detonation. And this is my
| desire/wish/prediction: at some point we will get an Uber for
| medicine. Americans will do most their telemedicine with
| doctors outside the united states, where education is free,
| there are not legal requirements or certifications or licenses,
| etc. This is what immigrants like myself do. A psychiatrist in
| argentina, for example, charges 5U$S for a visit, while one in
| Palo Alto, CA charges 1000U$S with a 3 month wait list.
| huitzitziltzin wrote:
| Lots of stuff here...
|
| >> Hospitals are 40% of the NH spending so I would even not
| look at doctors that way.
|
| Hospitals are 30% and physicians are 20%
|
| >> The market structure is such that there are very few
| doctors,
|
| Agree. Add more medical schools and residency spots.
|
| >> With a massive supply shock on doctors you would not only
| lower wages for doctors,
|
| Yes, this is a good idea.
|
| >> you would also lower admin costs.
|
| Not clear that this is true or why it would happen.
|
| >>One caveat, even though doctors wages are very high, they
| are also rent-captured by universities that charge mid six-
| digits for an education and medical insurance, and
| certifications that are burdensome and expensive.
|
| Medical school debt may be high, but salaries are higher.
| Certifications are not likely a large obstacle to more entry,
| IMO.
|
| >> I remember medical malpractice insurance going to several
| thousand a month for OBGYN.
|
| There are plenty of "tort reform" states that cap malpractice
| payouts. Medical services are not cheaper there.
|
| >> There is a reason why clinical doctors have an abnormally
| high suicide rate in the US.
|
| Source needed on this claim. Might be true. I'm skeptical
| though. High relative to what?
|
| >> Then hospitals get massive fed spending and money,
|
| They do and certainly in the COVID stimulus bill that was a
| HUGE waste of public money.
|
| >> plus often local protections that mean you cant open
| competing hospitals.
|
| This is called "certificate of need." These laws are dumb but
| don't exist in 15-20 states at this point. More entry would
| be great, but you need more doctors, more competition and
| more price transparency too.
|
| >> In the book " The Social Transformation of American
| Medicine" they talk a lot about how hospitals rent-seeking
| behavior is to turn themselves as a non-profit, and then ask
| for federal funding and getting that denied to for-profit
| hospitals, effectively capping the amount of hospitals you
| can open.
|
| Certificate of need laws are state, not federal.
|
| >> The WHOLE market structure needs a detonation.
|
| I'm on board. But by detonation I really mean: - more medical
| schools, - more doctors, including permitting foreign doctors
| to practice here - price transparency - meaningful
| competition among hospitals on price.
|
| >> And this is my desire/wish/prediction: at some point we
| will get an Uber for medicine.
|
| Amazon is starting an Amazon Care product. Looks like urgent
| care for the time being. My hope is that they open hospitals
| eventually.
|
| >> Americans will do most their telemedicine with doctors
| outside the united states, where education is free, there are
| not legal requirements or certifications or licenses, etc.
| This is what immigrants like myself do. A psychiatrist in
| argentina, for example, charges 5U$S for a visit, while one
| in Palo Alto, CA charges 1000U$S with a 3 month wait list.
|
| Great idea and this is what my (foreign born) wife does too.
| A great way to save money.
|
| For anyone else reading this far down, you can do it too.
| There are English speaking doctors everywhere.
| conanbatt wrote:
| Excited to read this!
|
| > >> you would also lower admin costs. > Not clear that
| this is true or why it would happen.
|
| There is an operational tax whenever you involve more
| people into the operation. You need to communicate, add
| paper trails, set up structure, etc. If say, you had one
| person collecting payments instead of a secretary, a doctor
| writing a paper, an insurance biller, an insurance agent,
| etc for the same ops, it would be a lot easier. You would
| have doctors perform many of these tasks. For example, give
| vaccinations, take vitals, etc.
|
| > Medical school debt may be high, but salaries are higher.
| Certifications are not likely a large obstacle to more
| entry, IMO.
|
| Thats the survivorship bias. Salaries cant be lower because
| people would go bankrupt. Certifications reduce
| competition, and make it harder to practice. There's even a
| startup that Raised a series A of multiple millions just to
| make this process faster (medallion). Evidence this affects
| the market is that most doctors are only licensed in a
| couple of states at most.
|
| > There are plenty of "tort reform" states that cap
| malpractice payouts. Medical services are not cheaper
| there.
|
| I'd like to see some data about this if you have it.
| Conceptually malpractice insurance is a fix cost that puts
| downward pressure on supply. IT is particularly salient for
| physicians that would like to work part-time.
|
| > Source needed on this claim. Might be true. I'm skeptical
| though. High relative to what?
|
| https://www.webmd.com/mental-health/news/20180508/doctors-
| su.... This is a well known fact in the profession.
|
| >> In the book " The Social Transformation of American
| Medicine" they talk a lot about how hospitals rent-seeking
| behavior is to turn themselves as a non-profit, and then
| ask for federal funding and getting that denied to for-
| profit hospitals, effectively capping the amount of
| hospitals you can open.
|
| > Certificate of need laws are state, not federal.
|
| The point above is that by making it impossible for for-
| profit hospitals to compete due to lack of subsidies, the
| supply is deliberately constrained.
|
| Cheers!
| mwerd wrote:
| Get rid of onerous documentation requirements. There - you cut
| 10%-20% of hospital administration costs, and you haven't
| changed how much doctors are being paid per hour, but you have
| increased their productivity, so they can see more patients for
| the same salary.
|
| Find me a payer who will agree to it and I'll show you the
| solution to healthcare bloat.
| lotsofpulp wrote:
| The documentation requirements did not come out of thin air.
| Some docs during the 80s/90s/00s made out extremely well. One
| of the infamous ones is ortho surgeons hitting everyone with
| dubious back surgeries since it was all paid for by Medicare
| even though there was little evidence back surgeries worked.
| chizhik-pyzhik wrote:
| I googled and was surprised to see just how much more doctors
| are paid in USA- about 2x as much as western european
| doctors... https://www.advisory.com/en/daily-
| briefing/2019/09/24/intern...
|
| Hospitals are also privately owned in the USA, whereas they're
| mostly government-owned in western europe. That's billions of
| dollars redirected from normal people towards rich
| stockholders.
| huitzitziltzin wrote:
| Most large hospitals are not publicly traded. The money is
| not going to rich stockholders because they don't have any.
| Many, for example, are large academic medical centers
| attached to universities.
|
| Also: most large hospitals are technically "nonprofit". Most
| of the money there goes to salaries for hospital employees,
| including well paid administrators.
|
| As I note elsewhere in a reply to another comment: it is an
| ongoing open research question whether "nonprofit" and for
| profit hospitals actually do anything different. My strong
| sense (indicated by my ""!) is that the answer is no! They
| are equally rapacious.
| conanbatt wrote:
| The fact that the majority of hospitals are non-profit is
| part of the racket. The money goes to the hospital
| administration instead of stockholders. That doesn't make
| it any better.
| huitzitziltzin wrote:
| No it isn't better. It just means that money is not going
| to "rich stockholders" as the parent asserts.
| sli wrote:
| > As much as everyone loves to complain about drug companies
| and insurers as being responsible for high US health care
| costs, that is not where the money goes. The money goes to
| doctors and to hospitals. (Specifically: about half of all
| national health spending to those two groups.)
|
| A big part of the problem is where the money _comes from,_ not
| just where it goes. People are less averse to doctors being
| paid well than they are being stuck with absolutely ridiculous
| bills that they cannot reasonably pay, which should go without
| saying.
|
| This is why so many people want to rich taxed much more heavily
| and that money used to subsidize healthcare, instead of the
| current trend of handwaving the wealthy as "not having liquid
| assets," something that never seems to matter when a wealthy
| person wants to pay for something expensive but suddenly
| matters when the working class wants the IRS to come knocking.
| If they need to dump stock or some other assets to pay their
| tax bill, that's their own problem and not anyone else's. It's
| also something that could be willfully avoided on their own
| accord.
|
| That $768B "defense" budget is absolutely nauseating in the
| face of medical debt being one of if not _the_ largest cause of
| bankruptcy in the US.
| psadri wrote:
| The problem in the US is the individuals don't pay for
| regular medical care - your insurance does. And that
| insurance is usually funded by employers. So doctors and
| hospitals have every incentive to squeeze the insurance
| companies as much as possible (which pass on those costs to
| employers).
|
| We'd be in a completely different situation if people paid
| for regular medical care out of pocket and paid for their
| catastrophic insurance by themselves. There'd be competition
| between health care providers to offer affordable care
| directly to individuals, just like other normal markets.
| rafale wrote:
| $768B is a great deal for not being under a russian or
| Chinese hegemony and world philosophy. Freedom comes before
| universal healthcare.
| huitzitziltzin wrote:
| You will be delighted to learn of the existence of (inter
| alia)
|
| - France
|
| - Japan
|
| - Australia
|
| - Great Britain
|
| - Finland
|
| - Taiwan
|
| - New Zealand
|
| - South Korea
|
| - and many more!
|
| All countries which do not spend anything like what we do
| on defense, are not under Chinese or russian domination,
| AND nearly all have longer life expectancy than we do while
| at the same time spending much much much less _on a per
| capita basis_ on health care than the US does.
| lp0_on_fire wrote:
| Each one of those countries you listed _heavily_ relies
| on the United States military being on their side in the
| event of a war. You can't make the argument you're making
| without at least acknowledging US hegemony (which we can
| argue is good or bad).
| triceratops wrote:
| In a war, I'd bet on a France-UK-Germany alliance against
| Russia any day. Ditto for a South Korea-Japan-Taiwan-
| India alliance against China. They might not win but
| they're strong enough to keep from being pushed around.
| lp0_on_fire wrote:
| > They might not win but they're strong enough to keep
| from being pushed around.
|
| Emphasis on "They might not win". Which is exactly why
| they rely on US support in the event of one of those
| scenarios - it increases their chances of winning by a
| lot.
| huitzitziltzin wrote:
| Totally agree with you! Sounds like the found a smart way
| to reduce their defense budgets, no??
| lemmsjid wrote:
| Thanks for the context. My layperson reader-of-newspapers
| understanding is that there are three issues with doctor
| supply: one is that it's expensive to become a doctor, which is
| hand in hand with spiraling educational costs, two is that it's
| painful to be a doctor, because of red tape, and three is that
| it is incredibly difficult to become a doctor and we actually
| don't have a lot of knowledge as to whether or not the rigorous
| selection process and training is actually completely necessary
| to produce a good doctor. In fact, the rigorous process might
| be selecting out people who would otherwise be good. (This
| being one commentary on the subject:
| https://www.baltimoresun.com/opinion/op-ed/bs-ed-
| op-0516-doc...)
| huitzitziltzin wrote:
| It is expensive, but they are extremely well compensated.
| Don't let them BS you. It doesn't take that long to pay back
| a million dollars of med school debt at a salary of 400k per
| year.
|
| Bigger issue is low supply: too few medical schools admitting
| too few students keeps supply Low and prices high. Current
| doctors love it. (That's the same reason non-US-trained
| doctors can't come to practice here. You can bet that they'd
| love to at our salaries!)
|
| Probably the training process is dysfunctional and needlessly
| brutal. But that doesn't make prices high on its own.
|
| Just open more med schools, add residency slots, and make it
| easier for doctors from other places to come here and
| practice.
| eecc wrote:
| The only change will be the introduction of Field Level Security
| to hide this information from screens for the wrong RBAC role
| cardiffspaceman wrote:
| So I think a lot of us in this forum had the same thoughts. But
| we also know a plausible story for how this person got her
| access: The original access level was sufficient for 85% (let's
| say) of her duties, and after she went to the other person for
| what she needed the other 1/7 times, they gave her the broader
| access level so she could do her job without interrupting
| someone at a higher pay grade, or on a different floor.
| mwerd wrote:
| Snooze. What is charged in healthcare is a distraction.
|
| This is likely a supply that would be used in an inpatient
| setting and will be completely written off as a "contractual
| discount and allowance" after the insurer pays the negotiated
| rate, which is based on the overall case and it's severity, not
| what supplies are used.
|
| This is lazy journalism meant to generate outrage without
| discussing the substance of the problem.
|
| Relax medical licensure requirements. Cap medical malpractice
| damages and chase the doctors' licenses instead of their
| pocketbooks. Allow nurse practitioners to provide higher level
| care. Allow telehealth and reciprocity for out-of-state
| licensure. Publicly fund more medical schools and residencies.
| Reduce burdensome documentation requirements and Medicare billing
| audit penalties.
|
| Just a few ideas that I think are more meaningful options for
| addressing healthcare costs.
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