The Mess We're In
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@Jolly said in The Mess We're In:
https://doctorbuzz.substack.com/p/reining-in-us-health-care-costs-step?sd=pf
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The title contains the term “free market,” yet the comparable countries cited as having lower cost and better outcomes have healthcare systems that are not “free market.” It’s like the author likes the idea of “free market” yet did not do the necessary homework to check if “free market” actually applies to what he writes about.
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The author advocates for “price transparency.” Great, I also like “price transparency.” Yet again, the author does not appear to have checked whether the comparable countries he cited upfront actually practice “price transparency.”
It’s like the author claims to like X, cite a bunch of comparable countries that may or may not have anything to do with X, then proceed to not learn anything for those comparable countries.
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He makes interesting points, and I agree transparency is a good step. But a lot of that exists now, mandated by the last administration. for the last hospital I was in, their prices are published. But it's up to the patient to take the time to compare, which I doubt many do.
“I am fond of pigs. Dogs look up to us. Cats look down on us. Pigs treat us as equals.” ~Winston S. Churchill
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The other thing I wonder about from that article is what goes into the healthcare cost figures. There isn't anything about that there. Are pharma expenses included? If so, then we are going up against nations with strict pharma price controls. It needs to be a fairly level playing field to be useful. I cannot say whether it is or isn't.
Medicare is trying the pay by a population with Medicare Advantage, which is this physician's approach writ large. I don't know if it is really saving patients' money or not. I elected for traditional Medicare because of better overseas coverage and that I did not have gatekeepers to go through to see specialists, etc. My brother selected Medicare Advantage, and although he probably pays $2500 less a year in premiums, he had to jump through a lot of hoops to get the treatment he needed for a nerve problem.
Any way you go there is going to be tradeoffs. I cannot help but believe some of the supposed quality differences between countries can be accounted for by a population that has grown up knowing they could see a doctor any time versus a population (us) who grew up seeing treatment as an expense, something they could not afford. There's a lot that goes into those figures that can't just be measured by money or outcome.
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He makes interesting points, and I agree transparency is a good step. But a lot of that exists now, mandated by the last administration. for the last hospital I was in, their prices are published. But it's up to the patient to take the time to compare, which I doubt many do.
@Mik said in The Mess We're In:
He makes interesting points, and I agree transparency is a good step. But a lot of that exists now, mandated by the last administration. for the last hospital I was in, their prices are published.
I recently looked up the "price list" published by a hospital, and found that while the physicians/surgeons' fees are published, the facility's fees/charges are not. E.g., want to do a surgery a certain outpatient surgery in the OR? The surgeon's fee and the anesthesiologist's fee for that particular type of surgery is published, but the costs for using the OR are not published. When it comes time to bill for the surgery, the unpublished hospital/OR charges exceed 2x the combined published fees for the surgeon and anesthesiologist. Disclosures with such major omissions do not help much to let patient "comparison shop." :man-shrugging:
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If one is not a person of means and doesn't mind playing the games, Medicare Advantage (depending on the plan) can be a very good choice.
Copays are usually low and you have some added benefits like some minor vision and dental stuff. But like any HMO plan (which it primarily is) , you want your docs to be in-network and be prepared for some limits on hospital stays or denial of some in-house rehab vs. home health rehab.
Traditional Medicare and a good Medigap policy are the most versatile. Not the cheapest, but most versatile, IMO.
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@Mik said in The Mess We're In:
He makes interesting points, and I agree transparency is a good step. But a lot of that exists now, mandated by the last administration. for the last hospital I was in, their prices are published.
I recently looked up the "price list" published by a hospital, and found that while the physicians/surgeons' fees are published, the facility's fees/charges are not. E.g., want to do a surgery a certain outpatient surgery in the OR? The surgeon's fee and the anesthesiologist's fee for that particular type of surgery is published, but the costs for using the OR are not published. When it comes time to bill for the surgery, the unpublished hospital/OR charges exceed 2x the combined published fees for the surgeon and anesthesiologist. Disclosures with such major omissions do not help much to let patient "comparison shop." :man-shrugging:
@Axtremus said in The Mess We're In:
@Mik said in The Mess We're In:
He makes interesting points, and I agree transparency is a good step. But a lot of that exists now, mandated by the last administration. for the last hospital I was in, their prices are published.
I recently looked up the "price list" published by a hospital, and found that while the physicians/surgeons' fees are published, the facility's fees/charges are not. E.g., want to do a surgery a certain outpatient surgery in the OR? The surgeon's fee and the anesthesiologist's fee for that particular type of surgery is published, but the costs for using the OR are not published. When it comes time to bill for the surgery, the unpublished hospital/OR charges exceed 2x the combined published fees for the surgeon and anesthesiologist. Disclosures with such major omissions do not help much to let patient "comparison shop." :man-shrugging:
Do you one better...The published fees are non-negotiated rates, if I'm guessing right. Usually, the negotiated rate (Blue Cross, etc.) is cheaper.
For years, I had a high deductible Blue Cross policy on my son. Reasoning? Even if he didn't meet the deductible on a ED or Physician Office visit, the negotiated rate was in effect. In the ED, that could mean the difference between a $1000 bill and a $3500 bill, for a somewhat minor problem.
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@Axtremus said in The Mess We're In:
@Mik said in The Mess We're In:
He makes interesting points, and I agree transparency is a good step. But a lot of that exists now, mandated by the last administration. for the last hospital I was in, their prices are published.
I recently looked up the "price list" published by a hospital, and found that while the physicians/surgeons' fees are published, the facility's fees/charges are not. E.g., want to do a surgery a certain outpatient surgery in the OR? The surgeon's fee and the anesthesiologist's fee for that particular type of surgery is published, but the costs for using the OR are not published. When it comes time to bill for the surgery, the unpublished hospital/OR charges exceed 2x the combined published fees for the surgeon and anesthesiologist. Disclosures with such major omissions do not help much to let patient "comparison shop." :man-shrugging:
Do you one better...The published fees are non-negotiated rates, if I'm guessing right. Usually, the negotiated rate (Blue Cross, etc.) is cheaper.
For years, I had a high deductible Blue Cross policy on my son. Reasoning? Even if he didn't meet the deductible on a ED or Physician Office visit, the negotiated rate was in effect. In the ED, that could mean the difference between a $1000 bill and a $3500 bill, for a somewhat minor problem.
@Jolly said in The Mess We're In:
Do you one better...The published fees are non-negotiated rates, if I'm guessing right. Usually, the negotiated rate (Blue Cross, etc.) is cheaper.
Indeed, for the examples I looked at, the in-network “negotiated rates” (not published) were anywhere from one fifth to one half of the published non-negotiated rates.
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I found it hard to read. Primary care physicians are notoriously bad at proposing macro solutions to the healthcare system - they’re looking through the wrong end of the telescope thinking they have the big picture.
It didn’t help that the two stats in his first paragraph are ridiculous, one lifted directly from Fauxcohontas’s shit research.
Having said that, transparency is a huge step in the right direction.
