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Paradigm Shift For The Healthcare Expense Monster

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Wolf Richter   www.testosteronepit.com   www.amazon.com/author/wolfrichter

A sadly familiar theme in the US—the growing ranks of the working poor—was fleshed out by the report, “Low-Income Working Families: The Growing Economic Gap.” But it did something else: it added graphic details to the conundrum of US healthcare spending. While it ballooned to $2.7 trillion, 17.9% of GDP, or $8,680 per capita, households have lowered their share. And so have businesses. What gives?

Despite improvements in the unemployment rate, 32.1% of all working households “may not have enough money to meet basic needs,” the report found. That was for 2011. In 2007, 28% of all families fell into that category. There are now 47.5 million low-income working families (earning less than 200% of the official poverty rate of $22,811 for a family of four). The report fingers in part the new job market. As people are finding jobs, they’re earning lower wages and have fewer benefits “compared with the middle-class jobs they held before.”

After housing expenses—81% of those below the official poverty level and 62% of low-income working families spent over 33% of their income on housing—and after day-to-day essentials, such as food and energy, little if any money remains for medical expenses.

But there is a parallel phenomenon: high-deductible health insurance plans linked to tax-advantaged IRA-like Health Savings Accounts. While deductibles range from $1,000 to $4,000 or more, the much lower premiums and tax savings can turn this into a bonanza for healthy people—if they keep their medical expenses down. The plans have taken off, much to the lament of healthcare providers. In 2006, only 10% of those with health insurance opted for a high-deductible plan; by 2012, their ranks had swollen to 34%!

These two large (and overlapping) groups—those who cannot spend more money on healthcare, and those who have a profit incentive not to—amount to a paradigm shift. They have lowered the household share of US healthcare spending. And it’s causing “unprecedented concerns” in the industry [The American Consumer Revolts Against Prescription Drugs].

But consumers aren’t the only players. This is the $2.7 trillion healthcare pie, a depiction of who pays what:

In 2011, households paid for 27.7% of all health care expenses—insurance premiums, out-of-pocket expenses, and supplementary premiums paid to Medicare. Year after year, they spent more than they’d spent the year before. But overall healthcare spending ballooned even faster, and as households were no longer able or willing to play along, they cut their share of overall healthcare spending.

In 1988, households paid for 36.8% of the total healthcare pie. Then their share declined, except for a slight rise during the late 1990s. The down trend was flattening out when the financial crisis hit. Layoffs washed over the land. Households axed healthcare expenses, cutting their share from 29.2% in 2008 to 28.3% in 2009. Despite a “recovery” in the job market, their share continued to drop, reaching a low of 27.7% in 2011.

Businesses, too, spent more year after year in absolute terms, but unlike consumers, their share edged up, particularly during the dot-com bubble. But when the bubble burst, the tightening began in earnest, reducing the business share from 25.1% in 2000 to 20.6% in 2011.

What gives? Consumers and businesses, responsible for over 60% of healthcare spending in 1988, have cut their combined share to 48%. Somebody had to pick up the difference. Well, yes. Governments. Particularly through Medicare and Medicaid.

The share of state and local governments edged up from 15% in 1988 to 16.4% in 2010 but then jumped to 17.4% in 2011. The share of the federal government rose from 15.9% in 1988 to a whopping 27.6% in 2011. Though that’s down from 28.3% in 2010!

The two groups, namely households and businesses, that had incentives—ranging from sheer survival to more profit—to push back against the healthcare industry, and that had at least some ability to do so, did. But government entities, subject to special-interest lobbying, went hog-wild. Greatest beneficiary: the healthcare industry. Over the years, it became the largest industry and one of the most powerful lobbies in the country.

But 17.9% of GDP may be more than the economy can bear—a glass ceiling of sorts. And healthcare spending has remained stuck there since 2009.

Now Congress might weigh in. Further limits on how much Medicare and Medicaid can pay for certain services or medications, or serious efforts to root out waste and fraud, might actually, perhaps for the first time ever, reduce the healthcare industry’s share of the economy—a dreadful thought for the industry. And it will do everything in its might to keep that from happening.

Now some fodder for the gun-control debate that the horrid events in Connecticut stirred into a frenzy, though it snoozed through the daily drumbeat of murders in Oakland, CA, a few miles across the Bay from me, or in Richmond to the north, or really in any other city. The fodder is inconvenient, however. For both sides of the debate.... How Americans Stack Up In Dying From Violence, War, Suicide, And Accidents.

 


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Wed, 01/16/2013 - 18:25 | Link to Comment Radical Marijuana
Radical Marijuana's picture

These are all automatically runaway systems, since they are based on deceits, indeed, a virtually infinite tunnel of deceits. The beginning of the American decline was privatized fiat money, made out of nothing, as debts, which took place bit by bit. The most symbolic event from long ago was demonetizing sliver, way back in 1874, which was achieved through banksters' bribery, through a covert legislative trick.  In my opinion that was the symbolic beginning of the long process that led to the "medical system" that we have today, which is primarily a "profit from disease system," NOT a "health care system."

American "money" was originally supposed to be backed by gold and sliver. Those materials cannot be made out of nothing, nor disappear to nothing, because they innately participate in the conservation of matter, as an aspect of the conservation of energy. Symbolically, American "money" was, and should have been silver, more than anything else. Instead, first silver was demonetized, then the Federal Reserve Board was created, which fed the system of the banks and the corporations that grew up around those banks, until finally, all pretense that that privatized fiat money was tied to gold was abandoned, and the privatized, fiat money-as-debt system was able to grow exponentially since the 1970s.

THE MONETARY SYSTEM IS THE RESULT OF RUNAWAY TRIUMPHANT FRAUD. The medical system was one of the many facets of that overall triumphant fraud. The profits made from being able to make "money" out of nothing were used to buy up more and more control over the political processes, the mass media, and the educational and research institutions. Bit by bit, there was a runaway triumph of FRAUD taking control over "medicine," in order to facilitate the runaway triumph of the "profit from disease system." Those observations set up my frame of reference to understand the deeper meanings which are aspects of the "Paradigm Shift For The Healthcare Expense Monster."

Of course, some radical paradigm shift is necessary. As I said, the first is to understand that we do NOT have a "Healthcare" monster, but rather, a "profit from disease" monster. Furthermore, the needed paradigm shift SHOULD be based upon human ecology, as the context in which the political economy of medicine actually operates.

The main means of going through "paradigm shifts" are to develop unitary mechanisms to understand these phenomena with, rather than continuing to rely upon false fundamental dichotomies, and the impossible ideals that those false dichotomies go along with.

MEDICINE IS INSIDE MILITARISM, BECAUSE EVERYTHING IS INSIDE MILITARISM. Medicine can not operate outside of being some sort of murder system. It already IS.  Indeed, if one roughly cranks the numbers, it is clear that American medicine is a death control machine, that kills an order of magnitude more people than the war machine does. However, I do NOT therefore recommend a return to false fundamental dichotomies, promoting old impossible ideals, as the "solutions" to that real problem. Rather, I recommend a greater use of information, and higher consciousness, with respect to those realities.

The PROBLEM is that the society became dominated by the biggest bullies' bullshit social stories, which promoted impossible ideals, in order that those would necessarily backfire, and make the opposite things happen in the real world. The PROBLEM is that the methods of organized crime were used to take covert control over governments. Thereby, the runaway triumphant fraudulence of the financial accounting systems were made and maintained.

On that basis of achieving the privatized ability to make "money" out of nothing, as debts, it became possible for that to spread through every other aspect of society. Like I said, the mass media, and in particular, the medical research and teaching institutions, were taken over through their systematic funding, along with a systematic corruption of the political processes to enact legislation and regulations that would advance the interests of those operating the "profit from disease systems." Thereby, mainstream medicine became dominated by the feedback from it making the most money, some of which profit was then able to continue to be used to corrupt the political processes, so that system could continue to grow BIGGER, and more INSANE!

However, there are no genuine solutions which do not address the root problem, which is why there must be RADICAL paradigm shifts.  The root problems relate to WHY there evolved militarism, which made War King, then made Fraud King: THERE MUST BE SOME MURDER SYSTEM, DOING SOME DEATH CONTROLS.

THERE IS! However, those systems which dominate America today are based on the runaway triumph of the maximum possible deceits.  After the basic monetary system became totally fraudulent, OF COURSE, that spread throughout ALL the components of the established social system. Thus, medicine became more and more fraudulent, and more and more primarily based on making profits, which could then be used to influence politics, to keep that system going and growing. (Of course, meanwhile, the society as a whole was becoming sicker and more insane overall.)

The POINT is that the money system is backed by murder. Therefore, medicine is within militarism. The only way that medicine can make overall sense is when placed inside of the context of the whole human ecology. However, our REAL human ecology was developed through conflicts, which enabled those who were the best at deceits to win the fights in the past, and therefore, for their bullshit to become the dominant social stories.  It is impossible for real medicine to NOT include some death control system. All attempts to banish or deny that only make sure it manifests in the worst possible ways, using the least information, and the least consciousness.

I especially agreed with this article above where it stated: "The two groups, namely households and businesses, that had incentives—ranging from sheer survival to more profit—to push back against the healthcare industry, and that had at least some ability to do so, did. But government entities, subject to special-interest lobbying, went hog-wild. Greatest beneficiary: the healthcare industry. Over the years, it became the largest industry and one of the most powerful lobbies in the country."

However, the needed "Paradigm Shift For The Healthcare Expense Monster" goes far beyond "some fodder for the gun-control debate" into the deeper issues of death control, and thus, the ways that medicine operates inside of militarism.

The paradigm shifts that are necessary require understanding how what made War King then made Fraud King. Those radical paradigm shifts require understanding the REAL WAYS THAT THE ACTUAL MURDER SYSTEM MADE AND MAINTAINED THE REAL GOVERNMENT. That is why "Healthcare" turned into the paradoxical "Monster" of making profit from disease, which drives more disease, in order to make more profits.

The REAL problems are due to the REAL militarism, which made and maintained the REAL monetary system, whereby the best organized covert gangs of criminals were able to control governments, more and more, in the current runaway systems of fraudulence, about EVERYTHING from militarism, to the monetary system, to the medical system.

The THEORETICAL solutions are the paradigm shifts needed to understand the actual history of the death controls, and thereby, to transform those systems to use more information, and higher consciousness, in order to accomplish the necessary purposes in superior ways. The PRACTICAL obstacles are that the established systems are based upon their already runaway triumphant deceits, which deny the basic social facts, and which therefore keep on backfiring worse and worse.

Paradigm shifts are to perceive what already exists through a radically different frame of reference. Primarily, in the context of this article, that requires we understand that money was backed by murder, and that, through those means medicine was taken over by a fraudulent monetary system, which then made medicine become a deceptive murder system. The ONLY actual good solutions require breakthroughs to understanding those realities, in order to be able to do those necessary things better than they are being done now. That is, there should be more information and a greater consciousness about the overall evolutionary ecology regarding the death controls, as those manifest through medicine.

However, in order to do that, we must begin with understanding how the historical murder systems made and maintained the established money systems. Our increasingly insane "Healthcare" is a "Monster" BECAUSE it manifests inside of a fundamentally fraudulent financial accounting system, where the profits made from those frauds are in feedbacks with political corruption, to drive worse and worse runaway triumphant frauds.

BUT, BUT, BUT, the return to "truth" about this should NOT be a return to impossible ideals, based on false fundamental dichotomies. Rather, the "truth" is radical paradigm shift, based on the axiomatic ideas of subtraction and robbery, as the basic ways to understand human realities, including everything from militarism to the money system to the medical system.

Wed, 01/16/2013 - 22:18 | Link to Comment OpenThePodBayDoorHAL
OpenThePodBayDoorHAL's picture

waaaaay too long dude

Wed, 01/16/2013 - 22:05 | Link to Comment Orly
Orly's picture

Blah, blah, blah.

You lost me at "gold," waaaaaaaay up the post.

Why is it that gold-bug types feel free to bomb any thread with something so completely irrelevant?

I don't get it.

:/

Wed, 01/16/2013 - 23:35 | Link to Comment Radical Marijuana
Radical Marijuana's picture

For a society to operate a "profit from disease system," it must have a fundamentally fraudulent accounting system. The way that system was made and maintained in the USA was to systematically drive the original money system, based on gold and silver, to become a privatized fiat "money" system, where that "money" was made out of nothing, as debt. That is the sine qua non for being able to build all the rest of the current social systems, whereby medicine became primarily done as a "profit from disease system," where every aspect of the medical establishment was taken over by those who made the most money, and therefore, were able to have the most influence over the politicians, to enact legislation and regulations to favour the "profit from disease system," as well as use that wealth to fund the medical research and educational institutions, including the medical journals, (as well popularizations through the mass media) so that, brick by brick, that entire shit-house of "profit from disease" could be made and maintained.

That insane runaway system of could not work without the sine qua non of a fraudulent accounting system at its foundation, and that FRAUD could not work unless the connections of "money" to silver and gold were severed, (which generally meant divorce from the laws of nature.)  This has been a step by step process, building for more than a Century. It is now automatically getting worse, faster. A hundred years ago, all the different kinds of medical practice were on a more even footing. Then, systematically, the "profit from disease system" was able to take over, and use legalized lies, backed by legalized violence, to destroy their competition, and thereby give the "profit from disease system" overwhelming advantages. There is a REPLETE HISTORY behind all of that, which has been well-documented to have occurred in America. Furthermore, anyone who takes the time to understand that BIGGER PICTURE will understand that it is a RUNAWAY situation, whose extreme evils go off the scale of any rational debate, since when the system gets based on profit from disease, then there is more and more disease. The social system as a whole gets sicker and sicker, and more INSANE, while those who benefit from becoming more wealthy inside of that system become even more able to dominate the political processes with their wealth.

Thus "Obamacare" is just the most recent of the runaway social insanities, which have been building and building for more than a Century, and which all trace back to overthrowing the monetary system backed by sliver and gold, and replacing it with a fake "money" system based on privatized fiat "money" made out of nothing, as debts. Without that fundamentally fraudulent financial accounting system, then a "profit from disease system" could not have been made and maintained.

It should be plainly obvious that the accounting systems control, and therefore, the triumphantly fraudulent accounting systems control fraudulent "profit from disease" medical practices. Of course, way too few people appear to be able to see the plainly obvious social facts. Instead, there are inane replies, like this, and the other one. THE FACTS are that the American "profit from disease systems" kill at least ten times more people than the American military do! Therefore, this is an EXTREMELY IMPORTANT TOPIC, that deserves being understood better.

However, instead, what is going to almost certainly happen is that the runaway frauds that control the USA are already fatal social sicknesses, that have already gone too far into social polarization. The fraudulent funding drives the triumph of fraudulent science dominating public "health" policies. It would take political miracles for the American systems, (which include its insane profit from disease systems) to recover and get better, instead of continue to automatically get sicker and sicker, until they die ...

Oh well, long ago I faced the fact that 99% of the people act like political idiots, which have been brainwashed to believe in bullshit, and therefore, are practically incapable of going through the PARADIGM SHIFTS in perception that they should go through, in order to understand their reality. The two replies to my comment only confirm that observation, yet again.

I am always PROVOKED when people talk about the need for "paradigm shift" ... but then fail to do that, in any but the most superficial ways. I attempted to provide a more thorough analysis of what the fuller paradigm shifting should become, in order to understand the FACTS presented in this article above, that the "profit from disease system" in the USA has become the dominant factor in the overall economy, and thus, the single biggest death control system. Furthermore, at present, the continuing crazy corruption of the political processes indicate that that is going to continue to automatically get much, much worse ... since the "profit from disease system" is a salient facet of the fraudulent financial accounting that controls everything else that America is doing!

Thu, 01/17/2013 - 00:12 | Link to Comment Orly
Orly's picture

Are you familiar with the term, "pithy"?  No one is going to read all that stuff.

Wed, 01/16/2013 - 17:46 | Link to Comment Traveler
Traveler's picture

Realty is missing from the Federal and State understanding of healthcare delivery and money budgeted to buy insurance. The last several weeks I have personally visited low income small employers via appointments made by a telemarketing agency, to understand the future, after 2014, once the affordable health care law kicks in. None, I repeat, none of the businesses or low income employees have any intention of spending 9.5 percent of income on a subsidized health plan, in 2014, here in California. Some business are becoming all cash based, with no w-2 employees, because the employees don't want the income reported, pay taxes, and get disqualified for MediCal and food stamps. They look shell-shocked that MediCal will morf into a subsidized health insurance plan in 2014, with no personal ability to afford their share of premium, and certainly no money to pay deductibles and coinsurance on top of the 9.5 precent premium. Everyone on the street level is seemly on a different planet, from public employees making policy pronouncements. The reality is cash based clinics are springing up, to serve the cash based employees. Today I talked with a popular tattoo business (10 employees all cash, no w2 employees) that does minor medical procedures, because they have all the sterilization, needles and scalpels already. They told me about a local house that treates gunshots for cash, and few would think of going to a regular doctor, because the police will get involved, and with priors, couldn't afford the legal troubles of using a hospital. Every low income community businees has their own bizzare story. Will these people buy Obama's insurance? No way.
Next we have the government employees, generally single payer advocates, trying to implement a government run exchange, that they don't believe in, because it's not single payer based, and they don't care it's a charade. They have no skin in the game. It's a train wreck, and that is OK, because their goal is single payer healthcare. Step one, demonize the current healthcare delivery. Two, increase the cost of insurance to unaffordable level. Three, create a quasi-doctor shortage, next introduce single payer as solution. Wash, rinse, repeat.

Wed, 01/16/2013 - 16:59 | Link to Comment Umh
Umh's picture

Ancient saying: what you subsidize you get.

 

It seems to me that the government is subsidizing all the wrong things.

Wed, 01/16/2013 - 16:56 | Link to Comment Encroaching Darkness
Encroaching Darkness's picture

Eventually, a multi-tier healthcare (CHS: "sickcare") system will evolve, if it hasn't already.

Level 0: traditional medicine, done by doctors who accept Medicare, Medicaid and all their problems of paperwork, shortchanging service fees, etc.

Level 1: Medicine done by doctors who don't accept Medicare or Medicaid; pay for it yourself, at time of service. Possibly keep your medical records private, as well.

Level 2: Medicine done by doctors who are "retired", or similar, under the table, for whatever the traffic will bear. Medical records (if any) are private, no government oversight.

Level 3: Medicine done by whoever, for cash, no records or anything. For the criminals, the desperate, and anyone else who must have privacy.

Or perhaps clinics will split: Partner A (Doctor A) is a Level 0 provider, Partner B (Doctor B) is a Level 1 provider next door / across the street, and so on.

Capitalism has a way of finding paths around bureaucracy, especially as the incentives grow and grow. I see a doctor at a university clinic, once or twice a year. Since I don't have insurance, I don't know if she gets paid or sends in her notes on me - but as the intrusiveness grows, I see doctors less and less.

Wed, 01/16/2013 - 16:52 | Link to Comment rsnoble
rsnoble's picture

For profit hospitals was a great idea.  Sure helped out. Yep, 2 hours in some fancy xray machine sets you back $10k.  

Wed, 01/16/2013 - 17:08 | Link to Comment newdoobie
newdoobie's picture

I asked my dentist "Doc do I need a full mouth X-Ray two times a year?"

His reply "As long as your insurance pays for it you do"

Wed, 01/16/2013 - 16:45 | Link to Comment Lucius Corneliu...
Lucius Cornelius Sulla's picture

Inflated prices in housing -- market dominated by government subsidies.

Inflated prices in healthcare -- market dominated by government subsidies.

Inflated prices in higher ed -- market dominated by government subsidies.

Inflated prices in military equipment -- market totally controlled by government.

Inflated prices in public road construction -- market totally controlled by government.

 

There seems to be a pattern developing here...

 

Wed, 01/16/2013 - 16:24 | Link to Comment adr
adr's picture

I'm pretty much going with the FUCK YOU ASSHOLES health plan.

I go to the hospital and then send them a check for what I think the service was worth. Say $150 for a couple stitches for my thumb. There is literally nowhere within 20 miles of me to get stitches other than the ER. We used to have prompt care clinics, but they shut them all down and put "GO TO ER" signs on the doors. The hospital claims I should pay them $1800 for a couple stitches.

So I got the bill, sent them a check for $150. A month later I get a call and I tell the hospital billing department to be happy with $150 because I was there for 20 minutes after waiting an hour in a room while my thumb was bleeding. I said I could have sent nothing, but that wouldn't be fair since the nurse did do some work. So be happy with $150 because 15 years ago I went to the ER for a severe laceration and the total bill was $80 without insurance. $150 is more than a fair payment for some thread, a needle, and a band aid.

I think I will start a new insurance company, you won't even pay premiums. You enroll in the FUCK YOU ASSHOLES HEALTH PLAN, and I'll personally tell the hospital to fuck off when your bill comes. EVERYONE WINS!!!!

Wed, 01/16/2013 - 17:32 | Link to Comment Odd Ball
Odd Ball's picture

Too bad the pay as you go clinics shut down - those are great.  $50 per visit, no insurance, no medicare, no BS.  There have been times I've gotten better medical advice from my vet than from doctors.  There's a thread above discussing vets.  I'm pretty sure your vet could have stitched up your thumb just as well as the ER.  Subtract your vet's price for a couple of stitches from the ER's price and you are left with the cost of the dysfunction in our healthcare system.

Wed, 01/16/2013 - 16:33 | Link to Comment flacorps
flacorps's picture

I didn't quite go that far, but I did quite legally send a provider less than half what it was demanding. Never lost a minute's sleep over it either.

This could work for a lot of people:

http://creditboards.com/forums/index.php?showtopic=324812

Wed, 01/16/2013 - 15:43 | Link to Comment Don Levit
Don Levit's picture

goatmug:

You may be right about the maximum deductible.  The PPACA also provides for "excepted benefits."  These are benefits of a separate plan which fill the deductibles of the major medical plan.

3 other people and I hope to introduce such a plan, in which paid-up coverage builds monthly.  For $300 a month, one can build $25,000 in paid-up benefits in 36 months, and $50,000 of paid-up benefits in 60  months.

These numbers have been run by Milliman, a well-respected actuarial firm.

This reduces the major medical premium by 60-80%.  We hope to provide this coverage through a not-for-profit insurer in 2014.

Don Levit

Wed, 01/16/2013 - 14:51 | Link to Comment Odd Ball
Odd Ball's picture

A few weeks back I wanted a phone consultation with my doctor.  They insisted I see them at the office - I guess there is no billing code for "phone consultation".  When seeing me they insisted on taking my weight, blood pressure and temperature.  I guess the only way they can bill for a few questions was to waste my time and that of a nurse.  This is what happens when a 3rd party becomes the payer (i.e. customer) be it an insurance company or the government.

Wed, 01/16/2013 - 14:39 | Link to Comment goatmug
goatmug's picture

Individuals and businesses have used a strategy of moving to higher deductibles to decrease health insurance premiums as they have risen over time.  Unfortunately, that game is up as the Affordable Care Act requires that the MAXIMUM deductible that any one person can have in the USA as of 1/1/2014 is now $2000.  

This requirement alone will increase health insurance premiums by at least 25% on each man, woman, and child in the US.

In October of this year the public will finally get a sense for the load of goods they've been sold as open enrollment will come and we'll get to see the true cost of these premiums under the new system.  In my estimation, premiums will increase at least 50% next year as a result of the various changes to insurer's pricing and requirements to on-board citizens with pre-existing conditions.

The striking thing will be that the base assumptions that the government uses will blow poeple away as they are now beginning to share their target premium costs with insurers.  Additionally, insurance purchasers will be mortified by the increased total out of pocket requirements they will now face (assumptions are now that through a combination of deductible and co-insurance a person will face up to $6250 in max out of pocket costs).  Imagine that, you'll pay 50% more for your premiums and be forced into a plan that provides poorer relative risk management!  

For more information about the specifics driving this year's cost increases I suggest reading the following; -

http://goatmug.blogspot.com/2012/11/4-reasons-your-health-insurance-will...

 

Goatmug 

Wed, 01/16/2013 - 16:26 | Link to Comment adr
adr's picture

I'm dropping my insurance if my premiums go up. I'm at $500 a month right now. My fucking mortgage is $585.

My health care premiums will go directly into a savings account, $500 a month adds up really quick. I will then go with the FUCK YOU ASSHOLES health plan I outlined below.

Wed, 01/16/2013 - 14:35 | Link to Comment Cynthia
Cynthia's picture

No one can overlook the fact (see link below) that most of the unnecessary costs in America’s healthcare system aren’t being generated at the bedside level, but instead they are being generated behind the scenes at the administrative level, which is taking on more and more characteristics of a bloated, broken bureaucracy.

One of main reasons why the burden of bureaucracy is bearing down on our healthcare system is because health insurers, private as well as public, have recently made the decision not to reimburse hospitals if they score too low on so-called “quality standards,” or if either their doctors or nurses fail to document the most minor or, in my view, the most irrelevant details about their patients. Insurers couldn’t care less if doctors and nurses properly diagnose and treat patients, thus improving their outcome and reducing their hospital stay, they ONLY care about finding excuses not to reimburse doctors and nurses for the care they give to their patients.

So as healthcare insurers hire more chart auditors (i.e. “care utilization managers”), who are very costly BTW, (their salary is roughly 20 to 30% higher than it is for a highly experienced critical/acute-care nurse), to comb through charts looking for shortfalls in quality standards, as well as charting errors and omissions, healthcare providers must respond by hiring more chart auditors (i.e. “care utilization managers”), who are just as costly as the ones being hired by insurers, to detect shortfalls in quality standards, as well as charting error and omissions, and see to it that these things are fixed or corrected. Otherwise, healthcare providers are at substantial risk of not being reimbursed by insurers. This escalating battle — I like to refer to it as an “arms race” — between providers and insurers must be put to a stop before administrative costs (i.e. wasteful red tape) outstrip the cost of providing actual care for patients!

http://www.ncbi.nlm.nih.gov/books/NBK53942/

Wed, 01/16/2013 - 16:49 | Link to Comment tango
tango's picture

I know for a fact that the meteoric rise in Medicare costs are partially attributable to bedside actions.  (Most doctor offices have gone as far as possible in reducing costs to the bone.)  I took care of my dad for years, in and out of nursing homes, and I assure you there is an incredible amount of unneccessary testing of those who don't know what planest they live on.  (Most recent absurdity - heart surgery for a friends mother-in-law who is 96 and has severe Alzheimers).

Of course, it is the system that has caused this.  Reimbursement rates are so low that doctors cannot survive on leisurely visits as was one the case.  They must make up the low payments with volume.   Further, they know Medicare ALWAYS pays regardless of the absurdness of the situation. It's as much the idea that folks deserve extensive (unnecessary) health care regardless of finances or mental state that drives this monster.

Wed, 01/16/2013 - 14:14 | Link to Comment Madcow
Madcow's picture

i think the plan must be to continue raising taxes and healthcare expenses - so that people are forced into bankruptcy - which would allow the bankers to foreclose on real property - so they can then sell that property to foreigners who have accumulated dollars. 

 

 

Wed, 01/16/2013 - 16:36 | Link to Comment tango
tango's picture

Madcow, that makes perfect sense (NOT!).  Why in the world would bankers - even if they were trying for world domination -work with Congressional Democrats to bankrupt Americans?  The last thing a rich person would want - unless they plan never to walk outside - is to surrounded 24/7 by a poor, vengenful throng whose intentions are not charitable. The rise in health care is not some dastardly plot but the logical consequences of our policies of "fairness" (if someone can afford it then everyone has a "right" to it and crony capitalism. 

Wed, 01/16/2013 - 15:39 | Link to Comment economics9698
economics9698's picture

The problem is the third party payer system.  This report is bad news because the source of the funding is coming from the worst possible source, government.  Simply put the government cannot and never will be as efficient in searching for the lowest cost as private companies, insurers, or the best source of saved money, the consumer.  Reducing the consumers’ share of the expense is a sure fire 100% guaranteed way to drive up heath care cost.

Heath care is so mind boggling stupid, disinterested third parties worried about votes or profit driving up the cost.

If health care were 100% private it would be affordable for everyone but the bottom 15%.  A easily served population through private charities. 

We know this because we have private cosmetic surgery, falling prices, and animal heath care which is 100% private.  Simply put if heath care were 100% private prices would HAVE to be affordable for the average American or the providers would be out of business.

Wed, 01/16/2013 - 21:50 | Link to Comment Orly
Orly's picture

Actually, it is done with smoke and mirrors.  Obfuscation.

Deals are made between insurance companies and mega-hospital corporations to set the prices for services rendered behind closed doors.  The patient is really the third party here.

Given that two entities can go into a smoke-filled room and decide a set price for everything from an MRI to gallbladder surgery, is it any wonder that each year they figure they need more?

The greatest scam in the world is the US healthcare system.  The patient has very little choice and, in fact, never sees the real bill.  How convenient.  They pay their co-pays and out-of-pockets but don't realise that there has been a 1000% mark-up on their needs without them having a say in the matter at all.

On top of that, it is most often the employer that pays the bulk of expenses as a benefit of having a job.  Benefits are being eroded, costs are sky-rocketing and the poor schlob who has a job keeps getting shifted from plan to plan year after year and watching that very thing of eroding coverage and increased money out of their pockets.

The MRI machine gets paid for, the equipment in the operating suite is paid for and there are no added costs to a hospital after that.  Yet and still, the costs of those services rises 10-15% every year.

It is time to ask why that is.  Unfortunately, it is ObamaCare that pulls the curtain down further on the obfuscation by allowing a narrowing field and tightening monopoly on the delivery of healthcare services.  The government gets to play favourites under the guise of trying to keep expenses down.

It really is a shame.

:/

Wed, 01/16/2013 - 16:25 | Link to Comment RichardP
RichardP's picture

We know this because we have ... animal heath care which is 100% private.

Not really.

http://www.petinsurancequotes.com/compare/pet-insurance-company-profiles...

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