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Guest Post: To Fix Healthcare, Let 100 Solutions Bloom

Tyler Durden's picture




 

Submitted by Charles Hugh-Smith of OfTwoMinds blog,

There is no one solution to something as complex and costly as healthcare; the solution is to let 100 solutions blossom and compete openly for citizens' money and trust.

I have addressed the systemic ills of U.S. healthcare, a.k.a. sickcare, for many years, most recently in ObamaCare: The Neutron Bomb That Will Decimate Employment (February 22, 2013). Over the years, I have presented a number of options to the present unsustainable, fraud-ridden, costs-twice-as-much-per-person-as-other-nations system that ObamaCare leaves intact:

The "Impossible" Healthcare Solution: Go Back to Cash (July 29, 2009)

Healthcare: A Large-Scale Solution (January 4, 2011)

A Sustainable National Healthcare System: Prevention Only (August 20, 2012)

How to Cut America's Healthcare Spending by 50% (August 21, 2012)

Nobody likes any of the practical solutions because everyone wants unlimited care and unlimited choice. Expectations in a system where the government can just borrow another $1+ trillion to pay the bills are high, and the feedback from reality, i.e. price, has been eliminated in the cartel/fiefdom system that is sickcare.

Everyone talks about "reform," but real reform is impossible in a bought-and-paid-for "democracy" like ours: Why Reform Won't Work (February 7, 2013).

Even more profoundly, the Central State and ObamaCare are the wrong unit size to provide healthcare that is transparently priced, accountable to the consumer, adaptable and decentralized.

What If ObamaCare, Too Big To Fail Banks and the State Are All the Wrong Sized Unit? (February 25, 2013)


We are so brainwashed by centralized models of authority ruled by the State that few can even imagine a system where the solution is not one centralized monstrosity ruled by a political/financial Aristocracy but a competing profusion of opt-in, transparent solutions.

Rather than have a single system, we need dozens of choices.

If there is a political desire for a national prevention-only system of clinics, then fine, let the State offer this, but with two stipulations:

1. It is voluntary/opt-in; nobody need participate if they choose not to

2. there is a cash co-pay for every service, medication, test. etc. Nothing is free, because nothing is free. What is presented as free is abused and squandered.

If a national superstore chain opens clinics that accept only cash, great. If employers want to offer healthcare insurance, fine; if they don't, that's also fine.

If some insurance companies want to offer medical insurance, fine. The only requirement is that the fees and coverage must be transparent enough and clear enough to fit on one piece of paper.

Every service offered by either the State or a private insurer or provider must be transparently priced on the web.

If the Central State does offer healthcare of any sort, it cannot be open-ended, because the funding is not open-ended. It must be strictly limited, either in what is offered or in the sum of money that can be spent on any citizen/patient.

You see the guiding principle here: patients are given the costs, the limits and the choices. There are often hard choices to be made, and rather than empower a State-run cartel/fiefdom system to make those choices, let each citizen make their own choices.

If a person wants to spend more than the sum allotted by the State or insurance, then they are free to spend their own money or appeal to charity.

There is no one solution to something as complex and costly as healthcare; the solution is to let 100 solutions blossom and compete openly for citizens' money and trust. If there is a political will for some sort of State-operated healthcare, then it must contain limits on the sum that will be spent per person and the care that is offered, and it must enable transparent pricing, wide-open competition and patient choice.

Perhaps cities want to offer some sort of public care; it's the choice of the city's voters and taxpayers. Maybe local private clinics want to offer their own limited form of insurance; they should be free to do so.

Centralized, top-down systems are quickly shorn of innovation and cost control as the political and financial Aristocracy soon capture the regulatory and governance machinery for their own benefit.

As I noted in The Pareto Economy (February 18, 2013), 80% of the benefits could be reaped for 20% of the money squandered on our corrupt, fraudulent, ossified centralized systems.

We suffer from a systemic failure of imagination. This is a theme I have explored many times:

Questioning "Progress" and the Poverty of our Imagination (June 11, 2010)

Oversupply of Old Failed Ideas, Undersupply of New Pragmatic Ideas (July 16, 2010)

Our Dust Bowl Economy (November 20, 2012)
When the present path cannot possibly lead to success, regardless of the labor and treasure poured into the effort, then risking the unknown by trying something different is the only way forward.

We Have No Other Choice (March 15, 2012)
America is just going through the motions because we have no other choice--or so we believe.

What If We're Beyond Mere Policy Tweaks? (February 6, 2012)

Spoiled Teenager Syndrome (January 3, 2013)

 

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Tue, 02/26/2013 - 18:37 | 3279577 pragmatic hobo
pragmatic hobo's picture

Healthcare insurance industry is a multi-billion profit generating industry. That money comes out of everyone's pocket seeking healthcare. Healthcare insurance industry is a vampire squid industry. Get rid of that industry and save that hundreds of billions on healthcare. Problem solved.

Tue, 02/26/2013 - 18:41 | 3279597 Gazooks
Gazooks's picture

public option

Tue, 02/26/2013 - 19:03 | 3279653 knukles
knukles's picture

It is past being un-fucked-up-able.
Like considering an optimal speed for QE.

Tue, 02/26/2013 - 19:09 | 3279672 FL_Conservative
FL_Conservative's picture

I'd create a "pay for service" medical service business model, but I'm sure that would get harpooned by HHS when the medical staff tried to re-license in the future.

Tue, 02/26/2013 - 20:13 | 3279863 Texas Ginslinger
Texas Ginslinger's picture

Once again another thread talking about the health care problem, but not offering the basic solution.

The basic solution = Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ 

Tue, 02/26/2013 - 20:17 | 3279884 Zap Powerz
Zap Powerz's picture

Yep. Pretty much.  The reason health care is expensive is because Americans are very sick people.  Americans have the highest rate of obesity and obesity related illnesses that just so happen to cost a shit ton of money to "treat".

If Americans were more healthy, health care would be cheap.

That is the solution.  Now, getting the fat, lazy Americans to that solution is an entirely different challenge.

Tue, 02/26/2013 - 20:19 | 3279894 nmewn
nmewn's picture

Minus one for taking up an entire screen to say two sentences.

Go on a word diet ;-)

Tue, 02/26/2013 - 20:22 | 3279906 atomicwasted
atomicwasted's picture

That'll do a lot of good for a broken leg, or Parkinsons, or pregnancy, or tuberculosis, or any number of expensive medical issues that have squat to do with diet and exercise.  Prevention is well and good, but people get way too wrapped around the axle of diet and exercise preventing everything.  It's like Christian Science wrapped with a bow of sanctimony.

Tue, 02/26/2013 - 21:13 | 3280081 Zap Powerz
Zap Powerz's picture

My broken leg is not your responsibility.

Tue, 02/26/2013 - 21:19 | 3280098 akak
akak's picture

Unfortunately, under Obama(don't)care, it now is.

Are you not your brother's keeper?  Yes you are!
So sayeth the Lord Obamessiah!

Tue, 02/26/2013 - 19:58 | 3279819 smlbizman
smlbizman's picture

the answers are not the problem....hell, we all know most the answers....the problem is man, and his greed.....everything that looks good on paper will not work once man gets involved.....

Tue, 02/26/2013 - 20:03 | 3279835 nmewn
nmewn's picture

(Audible gasp!)...you mean he was lying when he said he would cut the deficit in half by the end of his first term?!?!

Tue, 02/26/2013 - 20:19 | 3279892 Zap Powerz
Zap Powerz's picture

Obama did cut the deficit in half.  He also ended all the wars.  He made sure unemployment never increased above 8% and he single handedly saved the US economy from certain collapse. 

I mean, thats that they tell me on the TEE VEEEEEE.

Tue, 02/26/2013 - 20:22 | 3279905 nmewn
nmewn's picture

Yes, "he's, sort of a god."...to the state controlled media.

(Rolls eyes)...lol.

Tue, 02/26/2013 - 19:06 | 3279664 FL_Conservative
FL_Conservative's picture

Exactly!  If you want healthcare, PAY FOR IT YOURSELF!!

Tue, 02/26/2013 - 19:22 | 3279712 DosZap
DosZap's picture

Exactly!  If you want healthcare, PAY FOR IT YOURSELF!!

 

 

IF you can afford it. Checked the premiums for basic care?.$10k deductible,and you stil pay over $600.00+ per month.

Try checking rates for ONLY Catastrophic Coverage(the biggies),you will drop your teeth.

Millions cannot, so are they just supposed to die?.

Tue, 02/26/2013 - 19:59 | 3279822 smlbizman
smlbizman's picture

dos, i dont think he meant under this system....look at the top for his meaning

Tue, 02/26/2013 - 20:00 | 3279826 DosZap
DosZap's picture

10/4,thanks for the correction!

Tue, 02/26/2013 - 20:21 | 3279900 Zap Powerz
Zap Powerz's picture

"Millions cannot, so are they just supposed to die?"

What makes you think that their inability to pay for health insurance will automatically cause their death?

Tue, 02/26/2013 - 20:24 | 3279914 DosZap
DosZap's picture

What makes you think that their inability to pay for health insurance will automatically cause their death?

 

Because MANY treatable diseases with cures, would not be an option for them,who pays then?.Like the one I gave an example of.

No one, they are a statistic.

Tue, 02/26/2013 - 20:39 | 3279974 Zap Powerz
Zap Powerz's picture

I have more faith in human nature I guess. I just dont see people rolling over and dying without health insurance.  Humans didnt rise to the top of the food chain because they are dumb.  They'll figure it out.

Remember, brother zap, that necessity is the motherhood of invention.

Tue, 02/26/2013 - 21:33 | 3280132 Pure Evil
Pure Evil's picture

Billions currently live without health insurance and.....news flash.....are currently not flopping over and dying.

Health care is an expensive scam.

More people are killed per year from doctor/hospital/medication mistakes than the currently believed leading cause of death which is reported as cardiovascular disease.

Tue, 02/26/2013 - 20:24 | 3279918 akak
akak's picture

Quite possibly the same kind of servile, spineless, implicitly pro-authority mindset that makes so many believe the banksters' self-serving lies that the collapse of the current financial and monetary status-quo would automatically mean the end of civilization, if not the end of the world.

Wed, 02/27/2013 - 01:36 | 3280874 sethstorm
sethstorm's picture

Their death won't be immediate but it will certainly be a result of the inability to pay - due to the inability to get the proper care.

Tue, 02/26/2013 - 20:21 | 3279903 DeathBreath
DeathBreath's picture

we are all going to die.

try reading the article. the point is that if consumers had to bear more of the responsibility for payment, the costs would be lower

Tue, 02/26/2013 - 20:26 | 3279925 DosZap
DosZap's picture

try reading the article. the point is that if consumers had to bear more of the responsibility for payment, the costs would be lower

 

I agree 100%, but in order for the costs to get in line, there must be TORT reform, and get the frigging ambulance chasers out of the picture, except for major grievances, and negligence.

Wed, 02/27/2013 - 00:21 | 3280741 Umh
Umh's picture

I'm not defending ambulance chasers here, but they are a very small part of health cost. When you come straight to the point moral hazard is the biggest problem with the health care system in the US. That and people who would rather have a low routine vist bill and get it taken out of their paycheck every week along with processing cost....

Tue, 02/26/2013 - 20:33 | 3279950 Henry Chinaski
Henry Chinaski's picture

You are talking about health insurance.  Medical care is provided by doctors. You can have all of the affordable coverage in the world, but it won't save you if there aren't enough doctors.  

Tue, 02/26/2013 - 19:10 | 3279669 Ignatius
Ignatius's picture

Charles talks about simple solutions and there are many.

The problem: the American Medical Mafia.

Tue, 02/26/2013 - 20:11 | 3279854 kaiserhoff
kaiserhoff's picture

Exactly.  He is also advocated free markets and and open experimentation.  Maybe after the collapse, Charles.  Hold those thoughts.

Tue, 02/26/2013 - 21:12 | 3280077 Never One Roach
Never One Roach's picture

There will always be an unlimited demand for 'free stuff.' If everyone had a co-pay of some sort...some stake in the game, they may not abuse it as much.

Tue, 02/26/2013 - 22:28 | 3280339 EscapingProgress
EscapingProgress's picture

Healthcare is simple. Eat right, excercise, and have a lot of sex.

Sickcare and injurycare are where things get complicated.

Tue, 02/26/2013 - 19:21 | 3279610 MedicalQuack
MedicalQuack's picture

It is so complex, and they don't see things like this where United Healthcare figured out how to sell medical record data and basically is right up there to compete with the FDA Sentinel program that does the same thing, except now it's going to cost a lot more.

http://ducknetweb.blogspot.com/2013/02/time-has-come-to-license-and-tax-...

And on the other side, lets cut doctors pay a little more...

http://ducknetweb.blogspot.com/2012/12/unitedhealthcare-looks-at-doctors...

I forgot to add this on the doctors pay...the American Academy of Family Practice Physicians confronts United where due to complext contracts they contrive, doctors are getting paid less by Untied in several part of the county...ruthless are they not..

http://ducknetweb.blogspot.com/2012/12/the-aafp-confronts-united-healthc...

And now that that they are in there, let's head over to Medicare and tell them to aggressively start managing Medicare and Medicaid patients and they have the software and analytics to sell them..

http://ducknetweb.blogspot.com/2013/01/united-healthcare-wants-to-expand...

Tue, 02/26/2013 - 18:51 | 3279623 Stuck on Zero
Stuck on Zero's picture

A good place to start is to break up the American Medical Association (AMA) into competing groups. Let there be holistic practitioners, hi-tech practitioners, family practice, etc. etc.  The government gave this group of criminal misfits a monopoly over medical care and now Doctors are the richest group of people in the U.S. and their service stinks.

 

Tue, 02/26/2013 - 20:16 | 3279880 nmewn
nmewn's picture

I gave you an up for the body of what you said...not necessarily for playing the class warfare card toward the end.

Personally, I like the idea of the best being the most highly compensated and most sought after. Whether we're talking doctors, plumbers, electricians, painters, architects or even lawyers...lol.

It makes the lessers aspire to be their best and I can tell you from personal experience, there is nothing like a damned good lawyer ;-)

Tue, 02/26/2013 - 20:58 | 3280038 Stuck on Zero
Stuck on Zero's picture

Best?  The best way to judge the "best" is with free markets.  What we have today is crony capitalism and the AMA is the very essence of such.  Remember this:

Q: "What do you call the person who finished last in his class from the worst medical school in the country"

A: Doctor.

 

Tue, 02/26/2013 - 21:18 | 3280096 nmewn
nmewn's picture

lol...+1

And sure, it's that way for a lot of professions. Just cause "you got the plaque" on the wall doesn't make you the best.

That is decided by the market, the full waiting room to get to the best...not just seen and prescribed a pill. I think we're saying the same thing just looking at it from different angles.

Many "free market type" doctors are bailing out...taking early retirement or the younger ones not accepting anymore "government patients" for precisely this reason...their labor has value and they know what it is. Every professional does, even when they don't admit it among their peers...they know who the best is among themselves.

All that will be left in this "new improved system" is the bottom teir...the bottom of the class in the worst schools as you say, who can't demand the price for their service. The good ones have held on for as long as they're going to out of their own compassion...but that don't pay the rent.

Nothing in this life is free.

Wed, 02/27/2013 - 01:34 | 3280867 sethstorm
sethstorm's picture

Many "free market type" doctors are bailing out...taking early retirement or the younger ones not accepting anymore "government patients" for precisely this reason.

Those people are part of the problem.   Trying to inject politics into medical care through sabotage does nothing but make things worse off for everyone.

Wed, 02/27/2013 - 04:26 | 3281010 StychoKiller
StychoKiller's picture

So, not being willing to work as a Govt wage-slave is now sabotage?  Check yer premises.

Wed, 02/27/2013 - 04:24 | 3281008 StychoKiller
StychoKiller's picture

Graduating from Med school is only step one, then there's internship and residency, which weed out a lot of incompetents.

Tue, 02/26/2013 - 18:52 | 3279626 plane jain
plane jain's picture

Read the latest Time magazine cover story if you haven't yet.  

Medicare is super efficient.  Medicaid is hosed up by the individual states.  Allow people as young as 55 to opt in to Medicare @ a reasonable premium. Federalize Medicaid so that it is consistent across the states and let the same team that manages Medicare run it. Let Medicare negotiate pricing for drugs and durable medical equipment.

And, what should be an easy one, tell so called non-profit hospitals that they can not charge more than a maximum of 150% of the allowed Medicare charges and keep their non-profit status.  If they give up their tax advantage then they can charge whatever they can get.  

Tue, 02/26/2013 - 19:03 | 3279652 adr
adr's picture

The number of hospitals not accepting medicare is growing by the day. Why? because medicare won't pay $1500 for a band aid.

Tue, 02/26/2013 - 21:05 | 3280059 plane jain
plane jain's picture

True about Medicare not paying $1500 for a band aid.  They think that incidentals like gauze pads, tape, and sensors should be included in the facility charge.  But actually it is doctors that don't want to take Medicare, not hospitals.

“I was driving through central Florida a year or two ago,” says Medicare’s Blum. “And it seemed like every billboard I saw advertised some hospital with these big shiny buildings or showed some new wing of a hospital being constructed … So when you tell me that the hospitals say they are losing money on Medicare and shifting costs from Medicare patients to other patients, my reaction is that Central Florida is overflowing with Medicare patients and all those hospitals are expanding and advertising for Medicare patients. So you can’t tell me they’re losing money … Hospitals don’t lose money when they serve Medicare patients.”

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2M3bIfvnD

Tue, 02/26/2013 - 19:06 | 3279662 knukles
knukles's picture

Time magazine?
A silly dumbed down Yankee version of The Economist, for numbskulls.
Be lucky they don't change the format wherein all articles are limited to 40 character "Tweets"

Tue, 02/26/2013 - 19:51 | 3279803 JR
JR's picture

What tremendous information. Apparently that’s coming straight from the White House, filtered through the corporate media.

As to “everyone wants unlimited care and unlimited choice,” Charles, I like your article but I disagree with that. They don’t. They want the price down. They want common sense health care for a reasonable price. What they don’t want is to pay for other people getting thier health care free.

It reminds me of a joke:

A Russian arrives in New York City as a new immigrant to the United States. He stops the first person he sees walking down the street and says, “Thank you, Mr. American, for letting me come into this country, giving me housing, food stamps, free medical care and free education!” The passerby says: “You are mistaken. I am Mexican.” The man goes on and encounters another passerby. “Thank you for having such a beautiful country here in America.” The person says, “I’m not American. I’m an Israeli.” The new arrival walks farther, and the next person he sees he stops, shakes his hand and says, “Thank you for wonderful America!” That person puts up his hand and says, “I am from the Middle East. I am not American.” He finally sees a nice lady and asks, “Are you an American?” She says, “No, I am from Africa.” Puzzled, he asks her, “Where are all the Americans?” The African lady checks her watch and says, “Probably at work.”

And now the “Gang of Eight,” McCain, Schumer, Rubio, Menendez, Durbin, Jeff Flake, Lindsey Graham and Michael Bennett are working to drastically change forever the demographics of America with an immigration policy to please Obama that will push the nation ever closer to a third-world status  by giving virtual license to illegal aliens to continue working in the U.S. while being processed for permanent residency.

It only differs from what Obama envisions by failing, at this point, to allow homosexuals to sponsor their immigrant partners for citizenship.

Tue, 02/26/2013 - 18:53 | 3279629 Antifaschistische
Antifaschistische's picture

How about letting people choose.

Why can't four seasoned military combat nurses come back to the US and open their own "urgent care" practice?   Why does a PhD with a few experiences on a fetal pig have to put a few stitches in my cut hand?

Why can't a few nurses from the local hospital start their own clinic for kids with coughs and runny noses?

Why can't I get my own 800 mg Advil tablets without forcing me to go see a doctor.  This is total blackmail.

Why can't an orthopedic surgeon who performs 20 surgeries a week on dogs with ligament damage....even look at a human x-ray?

Why can't a few local paramedics open up their own burn clinic?

Competition in the medical field is outlawed...thanks to the incestuous relationship between the AMA, Washington and the Legal Profession.  Competition....is outlawed...you want to know why it cost so much for medical services...this is the one, and only reason. 

Tue, 02/26/2013 - 19:05 | 3279660 adr
adr's picture

But what if somebody gets hurt by one of those vets that looks at an X-ray? The jew lawyer will have a field day.

Don't forget about that problem as well. Layers and doctors are two sides off the same assrape coin.

Tue, 02/26/2013 - 19:15 | 3279684 freecrafted
freecrafted's picture

I would normally agree with you, but I'll give you an interesting story.

Back in the late 70s Carter an appointee that was responsible for the federal budget earmarked towards Medical education. His perfectly smart theory was that if he increased the quantity of people going through medical school he could invite more competition into the marketplace and competition would result in lower prices and costs would fall. Makes sense! What actually happened?

Costs exploded! Why? Because in a marketplace where almost every dollar spent is paid for by a 3rd party(government, insurance company, etc.) you have no concern for the cost of what you get. You'll gladly take the 10 times more expensive option with the marginal improvement in outcomes than take the cheaper option because it's not you that is paying for it. So under an environment where there is limitless demand of healthcare services it should be no surprise that as soon as supply goes up the demand immediately uses up that extra supply. Now you have more utilization and still higher costs yet. I know it's messed up and completely different than any other market in the US.

You can't expect the doctors to fix it because they're not even remotely interested in saving the government or insurance carriers money when they have a patient in front of them demanding the best because they're not paying for it. The only way to solve the problem is for the sick to feel responsible for the money spent on their behalf.

Being sick shouldn't be an excuse for spending other peoples money irresponsibly.

And the only reasonable solution to that is to have higher co-pays and deductibles so that people say "Hmm $10k for to see a specialist for my headaches of which I'll pay a $1k, nah I'll just go see a GP at a fraction of that." Only when that happens in mass will you see this rush for the best quality and most quantity after you get diagnosed subside. And when people start second guessing every extremely expensive option costs will fall.

Tue, 02/26/2013 - 19:21 | 3279699 McMolotov
McMolotov's picture

People can't do any of those things because it would dillute power and spread it among everybody. Can't have that, can we?

The drive toward centralization represents the drive toward total control. It's very easy to see a darker agenda lurking behind what's happened in healthcare over the past century. Once you abdicate responsibility over your own health and well-being to the State or a corporation, you exist solely at the discretion of the State or corporation. When your life is in the hands of a bureaucracy, you can be made to do anything that bureaucracy wishes.

For a short period of time, we lived relatively free from centralized powers dictating how we must live our lives, but that seems to have been an aberration, and now we've basically reverted to the mean. Human beings apparently like being told what to do, and despite our almost universal misgivings about monopolies, people have tolerated (and even encouraged) monopolistic or cartel-like behavior in healthcare.

And it doesn't matter whether it's in the public sector or the private sector. If the past few years have taught us anything, it's that there's very little distinction between government and the largest corporations anymore. In light of that fact, it makes absolutely no sense to believe centralized healthcare is intended to benefit any of us lowly serfs. It's meant to control us and enrich the right people.

Tue, 02/26/2013 - 20:10 | 3279849 LawsofPhysics
LawsofPhysics's picture

You clearly don't understand the value of management and MBAs or the liability issues, all of which are good things < sarc off >

Let me be clear, fuck the motherfucking paper-pushing useless fucks.

Wed, 02/27/2013 - 04:37 | 3281017 StychoKiller
StychoKiller's picture

Most of any hospital's administration exists for only one reason:  To jump through all the hoops that Medicare/Medicaid/Insurance Co.s require in order to get paid.

Tue, 02/26/2013 - 18:57 | 3279640 derek_vineyard
derek_vineyard's picture

thin the herd of those weak in mind or body---see y'alls on the other side

Tue, 02/26/2013 - 19:01 | 3279648 ebworthen
ebworthen's picture

Get rid of insurance completely.

It won't really be fixed until the entire scam is torn down and Doctors make what Nurses make, no malpractice just lose your license for three years, and the most common prescription is fluids, aspirin, and bed rest.

Tue, 02/26/2013 - 19:18 | 3279698 Bobportlandor
Bobportlandor's picture

I always thought a point system would be good.

Tue, 02/26/2013 - 20:37 | 3279965 nmewn
nmewn's picture

I don't even know why we have state licensing & certification...I mean whats the point outside of the state taking their cut?

No one sues the government when the doctor hacks off the wrong cancerous testicle...yet, the state gave the doctor the license to do it...it has no liability?

They can be (all professionals) accredited by their peers/customers/patients and that is more than enough...starve the beast ;-)

Tue, 02/26/2013 - 19:04 | 3279656 freecrafted
freecrafted's picture

This post is idiotic!

You want to see smart people who get the issue talk it over jump to this thread: http://www.fatwallet.com/forums/finance/1258425/

Bypass the OP who doesn't get it and it get's increasingly more interesting!

I doubt you could finish that thread without deeply understanding the problems going on in that market.

Tue, 02/26/2013 - 19:05 | 3279661 A Lunatic
A Lunatic's picture

As long as the government is playing favorites with other peoples money there will be no progress. You want to reform healthcare...........get rid of shit legislators, greedy lobbyists, subsidies, and other nonessential drains on the system, otherwise get ready for an already broken system to double down on expense while reducing quality and quantity of service; just like the fucking post office..............

Tue, 02/26/2013 - 19:08 | 3279670 knukles
knukles's picture

The new doctors.... the unusable USPS employees who've been through Federal Gubamint Job Retraining.
Booyah, motherfuckers!

Tue, 02/26/2013 - 20:11 | 3279851 A Lunatic
A Lunatic's picture

I hear that the TSA has already been cross-trained for pediatrics, gynecology, and proctology.

Tue, 02/26/2013 - 20:38 | 3279973 nmewn
nmewn's picture

The ultimate reach around...lol.

Tue, 02/26/2013 - 19:06 | 3279663 Piranhanoia
Piranhanoia's picture

The model for the UK or Canadian NHS works fine, costs the least, and with NO private companies involved.  It is like our Medicare without the private companies working overtime to defraud every payment angle.  The open market for health care would become a fear driven disaster like it is now.  Imagine your doctor;  "you have something only I know how to treat, but don't tell anyone or they'll all want it"

The UK is selling the NHS down the river and privatising it.  Got  to   wring   out   more money   from  the   poor   sick  dying   hypochondriac   rich   foreign  and   every  one we     can   screw.

Medicine for profit;  it has been tried and is an abject failure every time.

Tue, 02/26/2013 - 19:23 | 3279717 freecrafted
freecrafted's picture

British NHS is the worst healthcare system in the entire developed world. If you're to look to any European healthcare system look to the Swiss, Germans, etc. and that is very different than our Medicare which is the single most defrauded entity on earth.

Signapore has the best healthcare system in the world in matters of cost, quality, and improvement each year(which is something the socialist countries struggle with because they require substantially increasing budgets to just maintain quality if not have detiorating quality).

 

Signapore has a vibrant profit making healthcare system.

Tue, 02/26/2013 - 19:09 | 3279673 Uskatex
Uskatex's picture

I live in Italy and here we have a pretty decent healthcare system almost everywhere, at a cost lower than Japan and with he same life expectancy.
Medical visits and hospitalization are free, while drugs are subject to a fixed cost, if you are not poor.
In my opinion, one of the causes of high costs of US system are the too high compensations people can get with a good lawyer. You need a law limiting compensations to actual damages, with a cap of say 20,000$ on compensation for suffering. This would be a game changer!

Tue, 02/26/2013 - 19:19 | 3279704 adr
adr's picture

There are plenty of laws capping damages. In Ohio damages are capped at $250k unless the hospital kills you. Good luck finding a lawyer that will even take the case for a $250k max settlement. It isn't even worth thier time.

The problem is a 100% for profit system backed by an insurance system that forces people to have coverage just becausehelth care is so expensive. The fear of going bankrupt is the only reason why people have health insurance. After 2008 people didn't fear bankruptcy anymore so the US government decided to make it a law that you must have health insurance.

Every day more and more people are going with the Fuck You Assholes Health Plan. A hospital can't deny you care, when the $18k bill comes for a couple stitches, you pay them $250 and say be happy I paid you anything, FUCK YOU ASSHOLES!!!

Tue, 02/26/2013 - 20:21 | 3279902 DosZap
DosZap's picture

You need a law limiting compensations to actual damages, with a cap of say 20,000$ on compensation for suffering. This would be a game changer!

 

Yep, except WE will never see TORT reform here, due to the Dems OWNING the Lawyers.

And for the record, If you went into a hospital for testicular cancer in one nut, and after surgery you find out they TOOK the non cancerous one, (leaving you sterile, and a eunuch), would $20k be able to make you whole?.

NO friggin way.You just ruined my entire life!!!.

This shit happens all the time, you go in for a right leg removal, and wake up with the left gone.

$20k gonna make a living for ya, after they have to remove the BAD one?.

Don't think so.

Does their need to be ,limits?, damn straight,get the Lawyers 40% cut out of it, and limit total compensation to what one would earn over their lifetime, and then rates would go down.

Wed, 02/27/2013 - 11:34 | 3281762 Uskatex
Uskatex's picture

20k$ was a provocation. But I believe that 200k$ might be enough for the case you said, given that today you can substitute testicles with hormones shots, and you can adopt a child if you cannot have one.

 

Tue, 02/26/2013 - 19:11 | 3279675 dark pools of soros
dark pools of soros's picture

people keep thinking that healthcare is fucked up because people running it are incompetent..  hahaha... they know exactly what they are doing and want it to be even MORE expensive

Tue, 02/26/2013 - 19:13 | 3279678 adr
adr's picture

It is also illegal for a doctor to precribe medication to his own family. The $200 for five minutes of a doctors's time must be preserved.

$7500 for a CT scan, bullshit.

$1500 per hour for a hospital room, bullshit.

$500 for each of three "doctors" to look at a chart, bullshit.

$250 per pill for Advil, bullshit.

$100 for a bandaid, bullshit.

The #1 problem right now is that doctors are not paid by the hospital in most cases. The hospital bills you for the room and the nurse. You get a seperate bill for each quack that walks through the door. SURPRISE, your insurance works at the hospital but the doctor's practice isn't covered.

If you look middle class and are white and walk int a hospital, every person's eyes light up with dollar signs.

Tue, 02/26/2013 - 19:16 | 3279690 dark pools of soros
dark pools of soros's picture

exactly..  the hospital around here goes to the bars and puts in rufees to grab middle age white guys, drag them back and charge up their insurance while they are knocked out

sometimes for a whole weekend.. maybe $200k in charges

Tue, 02/26/2013 - 19:19 | 3279705 freecrafted
freecrafted's picture

You would maybe consider the same if you were constantly under threat of your hospital going under.

Tue, 02/26/2013 - 19:33 | 3279739 dark pools of soros
dark pools of soros's picture

what non-taxfunded entitlement country you live in? 

Tue, 02/26/2013 - 19:49 | 3279797 freecrafted
freecrafted's picture

Medicare and medicaid reimbursements are below hospital variable *and fixed* costs to hospitals. The hospitals engage in what is known as cost shifting in order to make up the difference.

And the vast majority of states every year default on the majority of their EMTELA(charity care) payments to hospital.

Everyone else(you and I) are stuck to pick up the tab for these losses which grow every year.

An operationally leveraged hospital can't do an X-Ray for $25 which is the Medicare reimbursement rate. We're stuck paying for the difference.

Tue, 02/26/2013 - 19:18 | 3279701 freecrafted
freecrafted's picture

Most of those costs are going to the hospitals.

The reason why the costs are so high is because the hospital is trying to cost shift away it's losses on Medicare, Medicaid, and charity care patients onto the people who can pay.

And, if you think the hospitals are screwing everybody than you're sorely mistaken. They're balance sheets are wastelands and constant struggle to stay in the black. Just about every year they have to raise their master charge book rates across the board to make up for the people they lose money on(after taking into account fixed costs) which are Medicare, Medicaid, and charity care patients.

Tue, 02/26/2013 - 19:27 | 3279732 adr
adr's picture

ha ha haa haa haa yeah right.

I don't know what books you've seen but I know people who are on te board of directors for The Cleveland Clinic. I can asure you they aren't having problems staying in the black. They are actually spending hundreds of millions per year to hide profit.

All that red ink must be why there are brand new $50 million medical centers going up in every town around me. Aultman hospital in Canton Ohio doubled the size of their medical campus without taking out a loan.

A doctor is paid $120 for an appointment by medicaid. Of course it is billed out at $250. If you can't make a profit off $120 for writing a prescription then you have real problems.

Tue, 02/26/2013 - 19:44 | 3279781 freecrafted
freecrafted's picture

Okay buddy!

First of all, where does a non profit hospital have to hide profit to? They don't have shareholders. They can't distribute profits. Do you even get the differences between legal entities? A hospital that books a 'profit'(net income) adds it to retained earnings. Practically every non profit hospital does that and then those retained earnings will go to one of a few places: future capital expenditure to improve quality, the ability to hold the line on pricing in the future, or **to keep in capital reserves against future unforeseen problems**(which is particularly important because non profits have limited access to capital markets--they can't sell stock in the future). Either way the intention is to always use it for the benefit of their customers(patients).

Furthermore, Cleveland Clinic is one of the most financially stable hospitals in the country. And major updates without loans are typically majority paid for by benefactors. There are actually endowments out there that specialize in just matching donor money in expanding hospital facilities.

 

Lasty, you have no idea what kind of costs hospitals have. The average doctor can only see about 15 patients a day. Out of those 15 appointments his income has to be covered and the nurses incomes have to be covered and the assistants need to be covered. They also need to pay a portion(called contribution margin) towards the lab technicians, the cleanings staff, claims departments, utilities, capital expenditues like new machinery, tools, etc.(hospitals are very capital intensive), etc. Now how much are they going to charge the patients who can pay when more than half of their patients are net losses to the hospitals and growing.

Think about it. Is thousands of dollars in charges for a simple test an act of greed(by a non profit entity non the less) or an act of desperation? Use your brain.

And I know more about this issue than you do! 

Tue, 02/26/2013 - 22:04 | 3280249 plane jain
plane jain's picture

Public/county type hospitals are in bad shape because they have to take everyone (more or less) and then they often get shafted by the state.  I don't think that is the deal with most hospitals though.  FWIW I worked in the corporate finance department of a big non-profit hospital chain and never heard anyone crying that they had to gouge the regulars to cover charity care.

 

To the extent that they defend the chargemaster rates at all, the defense that hospital executives offer has to do with charity. As John Gunn, chief operating officer of Sloan-Kettering, puts it, “We charge those rates so that when we get paid by a [wealthy] uninsured person from overseas, it allows us to serve the poor.”

A closer look at hospital finance suggests two holes in that argument. First, while Sloan-Kettering does have an aggressive financial-assistance program (something Stamford Hospital lacks), at most hospitals it’s not a Saudi sheik but the almost poor — those who don’t qualify for Medicaid and don’t have insurance — who are most often asked to pay those exorbitant chargemaster prices. Second, there is the jaw-dropping difference between those list prices and the hospitals’ costs, which enables these ostensibly nonprofit institutions to produce high profits even after all the discounts. True, when the discounts to Medicare and private insurers are applied, hospitals end up being paid a lot less overall than what is itemized on the original bills. Stamford ends up receiving about 35% of what it bills, which is the yield for most hospitals. (Sloan-Kettering and MD Anderson, whose great brand names make them tough negotiators with insurance companies, get about 50%). However, no matter how steep the discounts, the chargemaster prices are so high and so devoid of any calculation related to cost that the result is uniquely American: thousands of nonprofit institutions have morphed into high-profit, high-profile businesses that have the best of both worlds. They have become entities akin to low-risk, must-have public utilities that nonetheless pay their operators as if they were high-risk entrepreneurs. As with the local electric company, customers must have the product and can’t go elsewhere to buy it. They are steered to a hospital by their insurance companies or doctors (whose practices may have a business alliance with the hospital or even be owned by it). Or they end up there because there isn’t any local competition. But unlike with the electric company, no regulator caps hospital profits.

 

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2M3osmTo7

 

 

There is nothing special about the hospital’s fortunes. Its operating profit margin is about the same as the average for all nonprofit hospitals, 11.7%, even when those that lose money are included. And Stamford’s 12.7% was tallied after the hospital paid a slew of high salaries to its management, including $744,000 to its chief financial officer and $1,860,000 to CEO Grissler.

In fact, when McKinsey, aided by a Bank of America survey, pulled together all hospital financial reports, it found that the 2,900 nonprofit hospitals across the country, which are exempt from income taxes, actually end up averaging higher operating profit margins than the 1,000 for-profit hospitals after the for-profits’ income-tax obligations are deducted. In health care, being nonprofit produces more profit.

 

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2M3pjvqbt

 

And charity care is usually reported at bloated chargemaster rates, not what it actually cost the hospital.

That report doesn’t cover the executives overseeing the chain, called Mercy Health, of which Mercy in Oklahoma City is a part. The overall chain had $4.28 billion in revenue that year. Its hospital in Springfield, Mo. (pop. 160,660), had $880.7 million in revenue and an operating profit of $319 million, according to its federal filing. The incomes of the parent company’s executives appear on other IRS filings covering various interlocking Mercy nonprofit corporate entities. Mercy president and CEO Lynn Britton made $1,930,000, and an executive vice president, Myra Aubuchon, was paid $3.7 million, according to the Mercy filing. In all, seven Mercy Health executives were paid more than $1 million each. A note at the end of an Ernst & Young audit that is attached to Mercy’s IRS filing reported that the chain provided charity care worth 3.2% of its revenue in the previous year. However, the auditors state that the value of that care is based on the charges on all the bills, not the actual cost to Mercy of providing those services — in other words, the chargemaster value. Assuming that Mercy’s actual costs are a tenth of these chargemaster values — they’re probably less — all of this charity care actually cost Mercy about three-tenths of 1% of its revenue, or about $13 million out of $4.28 billion.

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2M3q6MGIj

Tue, 02/26/2013 - 22:37 | 3280361 freecrafted
freecrafted's picture

The same article that spawned this thread: http://www.fatwallet.com/forums/finance/1258425/

And watch as how the people on there tore it apart.

And large hospital chains get scalability benefits(i.e. since hospitals are high fixed cost enterprises the more patients can you fit per fixed cost the lower your contribution margin has to be which releaves pressure on hospital books--that is why large hospital networks like Mayo, Kaiser, Intermountain, Gunderson, John Hopkins, etc. all have relatively stronger financial positions). That is why you didn't hear anybody complaining because you were in a best of breed hospital. On the flip side a I have a relative that works high up in healthcare consulting and goes around from hospital to hospital. Trust me their balance sheets are collective wastelands. 

First of all, operating margin does not equal profit margin. Operating margin excludes capital expenditure which is all one time expenditures by a hospital. Hospitals are among the highest capex businesses in the country so touting operating margin data is just nothing more than data manipulation to sell a story that doesn't exist.

Non profit entities don't have shareholders. They don't issue dividends and don't distribute 'profits'. When there is net income at the end of the year they book it to retained earnings for: A) Future capex to boost quality or quantity of services B) Act as a cushion against future price increases or C) *Held against future unforeseen costly problems(which is particularly important to a non profit hospital because it's both operationally leveraged and has limited access to capital markets--I.e. it can't sell stock).

Charity Care is filed under state protocal for determining hospital losses and determined by the state(of which the state will usually default on anyway). That often times isn't chargemaster rates so the article is just wrong there. Furthermore, hospitals need to maintain 30% of charity care financing through benefactor donations in order to be considered for EMTALA reimbursement. That 30% mark puts a cap on total declared charity care losses.

 

So that article is groslly wrong about cost shifting. Medicare, Medicaid, and charity care reimbursements are substantially below cost. People with insurance policies have their insurance companies negotiate prices over a long term contract which means hospitals can't raise those rates easily. So if you need to releave pressure to put your hospital back in the black the easiest place to go is the chargemaster book. And how grotesque those things have become is actually a useful metric for understanding how bad cost shifting has become in most hospitals. The hospitals are forced, they have to keep their hospital afloat and that is the easiest place to go. Many of those extreme costs are an act of desperation to save the hospitals.

Or you can just believe that it's a giant conspiracy by an entire industry to gouge you because that just makes so much more sense(rolls eyes). 

Wed, 02/27/2013 - 04:48 | 3281025 StychoKiller
StychoKiller's picture

Actually, it's unethical for a Doctor to prescribe medication for their own family, not necessarily illegal.

Tue, 02/26/2013 - 19:24 | 3279720 DosZap
DosZap's picture

Every day more and more people are going with the Fuck You Assholes Health Plan. A hospital can't deny you care, when the $18k bill comes for a couple stitches, you pay them $250 and say be happy I paid you anything, FUCK YOU ASSHOLES!!!

 

That only works ONE time at each hospital.After that they WILL not treat you period.

Tue, 02/26/2013 - 19:27 | 3279733 Waterfallsparkles
Waterfallsparkles's picture

Why does no one talk about costs?  How can they charge $10. a pill that cost $1.?  Why do we pay so much for drugs when the Pharma Companies literally give them away to Foreign Governments?  Maybe they should reverse that and charge Foreign Government what they charge us and give it away to American Citizens.

Why does the Doctor accept $20. for treatment from Medicare but charge a private person $200.? 

Maybe they are being paid way to much Money.  If Obama Care is Nationalized.  Maybe we should Nationalize the Doctors, Hospitals, Pharm Companies.  To reduce costs.

Wed, 02/27/2013 - 04:53 | 3281031 StychoKiller
StychoKiller's picture

[qoute] How can they charge $10. a pill that cost $1.? [/quote]

It's just like those $700 hammers procured by the Pentagon.  The manufacturer is quite willing to sell the military a $15 hammer, but after all the testing to MIL-SPECs required and the two-foot high stack of paper documenting that the hammer is indeed fit for pounding nails, the cost shoots up to $700.

Now, WHO requires the military to prove that they're not wasting taxpayer's munny?  I'll give you 535 guesses.

Tue, 02/26/2013 - 19:44 | 3279775 DosZap
DosZap's picture

Well, this will work itself out soon enough, 5% of all Dr's are going to leave their practices in the next 4-5yrs.

Most Dr's are already turning down Medicare patients due to ObaMao cuts in Medicare pmts to Dr's.

With the current outlook for what a NEW DR. will be allowed to make, look for far fewer to enter the field.

Premature death of a typically healthy patient is going to up exponentially.Example if you are 50-60yrs old and get a URI Infection, and do not get it treated, you will have pnuemonia usually within a week after it enters the lungs.

Left untreated your ass is dead.When all it would take is a $30.00 scrip for a Z Pack, To save your life,but to get that scrip, will cost you $300/$400.00 at a Emg clinic.

I currently have excellent coverage,that cost's me $4,500.00 a year,total cost thru company is $16k.

This same plan is not available to me,at any cost, as even though I am not poor,nor am I wealthy(by many here's stds) I am not, or a multimillionaire.

Try eating a $16k+ a year policy( that turns into a $42k a year policy after losing your employers pay in, and w/no job) out of your retirement funds, and you won't have any funds for anything in a short time.(You are basically Unemployable in America now if your over 50yrs old.(unless it's a menial job, with ZERO benefits.)

Tue, 02/26/2013 - 19:49 | 3279796 mirac
mirac's picture

The options...

Have a child a make him/her become a doctor

Live a healthy lifestyle and learn to heal yourself-parachuting is out

Quit healthcare and if everyone gets on the bandwagon-bankrupt the whole lot

Tue, 02/26/2013 - 19:56 | 3279816 Waterfallsparkles
Waterfallsparkles's picture

The higher the costs for Health Care the more the Private Health Care Companies make.

The higher the cost of Health Care more People need to buy Insurance.  Most do not want to be wiped out by un planed and the high costs for care. 

Yet, when there is Insurance the providers charge more because it is being paid by someone else, not the patient.  If they charged the Patient what they charge the Provider they would lose Patients and everyone would SHOP for care and ask what the procecure would cost.  This needs to be avoided at all costs.  Better to overcharge the Provider and spread the costs over all the Insures.

But, if people had to pay for their care the cost would come down as everyone would shop for service trying to find the best costs provider.  With the pass the overcharged buck to the many thru the insurance company, costs everyone dearly.

 

Tue, 02/26/2013 - 20:21 | 3279901 besnook
besnook's picture

for profit medicine does not work. the financial incentive distorts the the value and supply of the goods and services that are supposed to be sold, good health and care. so the key is to make good health and efficient care the primary profit center. turning the profit motive over to the patient, in the form of being alive and well, is the only way a for profit plan can work.. it cannot be done in a for profit system.  that is the conclusion most of the free world has come to so they have chosen the lesser of two evils, a single payer .gov as insurance provider model. of course, that brings upon an entirely different set of problems but there are many examples of success around the world. a prudent .gov would chose the best parts of them all but the usa does not have a prudent .gov so we are stuck with what we have rendering this discussion more utopian gibberish.

Tue, 02/26/2013 - 20:41 | 3279975 akak
akak's picture

Your argument could equally (and needless to say, erroneously) be made about ANY sector of our economy, justifying government takeover and centralization in the name of "efficiency" and "fairness".  Down that road lies Lenin's totally centralized USSR --- which even he backed away from.

Tue, 02/26/2013 - 21:13 | 3280047 besnook
besnook's picture

no healthcare is a special anomaly of economics. there is no elasticity of demand. people will pay their last dollar to receive care, even inadequate care. there is no marginal utility. one never tires of healthcare if it will prolong one's life. there are no substitutes or complements. i suppose you could cite acupuncture or chiropractics or voodoo but you don't get the choice of which bypass surgery brand you get to buy or the choice of amputation procedures. you get healthcare and since paying cash for medical care is out of the reach of practically everyone you can't choose which same procedure you can buy based upon price. so you have on the one side an insursnce company you are locked into(the fed .gov's choose your own policy has had no effect on prices paid for insurance despite the supposed competition) with an incentive to reduce their cost to maximize profit(denying you coverage) against companies who want to charge the upper limit price to maximize their profit(care you don't need).

it is not like any other industry where you have a wealth of choices at every price level, at every service level, at every level....or at no level. the closest thing to it is monopoly pricing power but even that doesn't have the advantages of the healthcare industry.

Tue, 02/26/2013 - 21:27 | 3280108 freecrafted
freecrafted's picture

Wrong, wrong, wrong!

There is no elasticity of demand when all of your cost is being paid for by some other entity. That would be true any industry. If I told you that after you paid $5k a year you could use my boat any time you wanted to what would you do? You would use it all the time. That is inelasticity of demand right there and comes with any ongoing service that you pay a fixed amount for regardless of useage.

If there truly was no elasticity of demand with peoples own money than we would benefit from that, but since it's covered by everybody else the opposite happens our costs go up.

 

If I'm a wealthy guy and I spend $300k of my own money to prolong my life by a few months than my cash gets used to pay more contribution margin to the hospital releaving pressure on the hospitals books and therefore plays a very small role in preventing forced price increases. 

Now if I'm a normal person and I spend an insurance companies $300k to prolong my life by a few months than the insurers cost rise by the same amount playing a small role in raising other peoples premiums. The hospital itself might get temporary relief like in the case of the guy paying cash, but this 'billing the system' is actually more dangerous.

So no the problem with healthcare is that we've created a situation where people have a limitless demand for quality and quantity paid for by someone else and that creates extremely inelastic demand like it would any industry.

Tue, 02/26/2013 - 20:34 | 3279948 Bicycle Repairman
Bicycle Repairman's picture

Decentralize.  Localize.  Deregulate (free market reforms). Increase real choice.  Make people responsible for their choices, including lifestyle and purchasing services.

Today's problem is Obama-care was a step in the wrong direction at a time we we can least afford colossal, stupid mistakes.  If a crisis ensues and we end up with single payer, then so be it.  All I ask is that the people who provoked the crisis be hung.

Tue, 02/26/2013 - 20:38 | 3279970 besnook
besnook's picture

there is one important side benefit to obamacare or the health insurance company enrichment act. for every 3 full time employees a small company will have to cut hours for to stay under the magic 30hrs number they will have to hire another employee.

Wed, 02/27/2013 - 05:06 | 3281041 StychoKiller
StychoKiller's picture

Doctor sez to the patient:  "I've got good news and bad news, which do you want first?"

Patient: "Give me the bad news first, Doc."

Doctor:  "The bad news is we had to amputate both your frost-bitten feet."

Patient:  "Okay, what's the good news?"

Doctor:  "The patient in the next bed wants to buy your shoes."

 

Your so-called benefit ain't so great to the employees getting their hours cut, when they haven't received a decent raise in years.  All this does is add MOAR inefficiency into the Economy -- do you work for The Bernank?

Tue, 02/26/2013 - 20:45 | 3279989 Henry Chinaski
Henry Chinaski's picture

I am lucky to have an old school family practice physician, even though he is pretty young.  A while back, I had an gardening mishap requiring a few stitches. I was going to drive to the ER, then decided to try my Dr. first.  He wanted to send me to the walk-in urgent-care clinic, but I wouldn't take no for an answer.  I said "Doc, all you do is hand out pills all day long.  You can do some real doctoring and it will be fun!"  He checked his schedule and set an appointment for a couple of hours later and I bandaged my cut and finished the yard work.  He stitched me up and I was out of the office in about 20 minutes.  I could tell it made his day. I wish there were more doctors like him, and that they would would only accept cash and we could all tell the insurance industry and the government to fuck off. 

Tue, 02/26/2013 - 21:15 | 3280089 besnook
besnook's picture

i once had a veternarian like that. i have one similar today but most of his colleagues have adopted the human healthcare model since there are more and more customers who will pay anything to save poochie and kitty.

Wed, 02/27/2013 - 05:08 | 3281042 StychoKiller
StychoKiller's picture

So, WHEN is some raving bureaucrat gonna come up with Medipet?

Tue, 02/26/2013 - 21:29 | 3280123 Chris88
Chris88's picture

Who needs 100 solutions, I have one: the market.  

Tue, 02/26/2013 - 22:14 | 3280293 plane jain
plane jain's picture

Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot. People fare differently according to circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or they’re protected only partly by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow know the prices before they get billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2M3s87tcb

It just isn't that simple.  Requiring healthcare providers to get a patient signature on a treatment plan with prices before the treat and charge would be at least a start as far as an informed consumer.  Not practicable of course if you are unconscious.

Tue, 02/26/2013 - 22:39 | 3280403 freecrafted
freecrafted's picture

See post above where I debunked the central bull$hit of that article.

Tue, 02/26/2013 - 23:22 | 3280567 newengland
newengland's picture

Meanwhile, MA is held up as a template for future sick care in the USA.

The bureaucracy of the MA system drives everyone crazy, regardless of whether one is rich or poor. It is a typical government creation: a horse designed by a committee that turns out to be a lumbering camel. 

Politicians and regulators fan their own ego when they think that they can deliver a 'fairer' system. 

The ruthless market of consumer chooses service is best in order to drive down prices and improve service.

Never underestimate the lobbying power of the pharmaceutical industry and its paid pets in DC.

Tue, 02/26/2013 - 23:54 | 3280680 freecrafted
freecrafted's picture

After it was enacted costs exploded and all of that got picked up by the states *non profit* health insurers(who make up 90% of the Mass market). They then tried to prevent rate increases so the insurers just shut down the market. Finally the state acquasced and have watched has premiums have skyrocketed further. People are now b!tching about their premiums so what now is the state's great idea? Price controls. They're going to try to institute price controls in the hospitals. All that is going to do is transfer these massive costs onto the hospital balance sheets and blow them up. Seriously you can't make this stuff up.

The people of Mass. are f&cking retarded. 

Wed, 02/27/2013 - 01:32 | 3280862 sethstorm
sethstorm's picture

Markets and healthcare are two that generally shouldn't be meeting - especially for how the former causes deadly corner-cutting in the latter.

Doubly so for HSA's which are only good once and then you're screwed the next time around.

Wed, 02/27/2013 - 02:09 | 3280908 Pa Kettle
Pa Kettle's picture

There will never, ever, under any circumstances, be a rational solution to health care that is based on it being a profit-making industry.

Never. Full stop.

It is either a charitable activity based on human kindness and caring, or it is money-grubbing rip-off funding obscene paychecks.

All "health care insurance" of any description is a feeding tube for souless ghouls to suck the life out of the victims. All government sponsored "health care insurance" is a direct feeding tube from the government to the fat-cat health care syndicate, especially the "legal" drug cartels. <SPIT!>

Wed, 02/27/2013 - 02:47 | 3280941 freecrafted
freecrafted's picture

So if I pointed to countries where for profit healthcare works fine or is even a raging success what would that make you? Ignorant or dumb?

Wed, 02/27/2013 - 05:11 | 3281048 StychoKiller
StychoKiller's picture

Do they also distribute EBT cards?

The free-shit army DEMANDS free-shit!

Wed, 02/27/2013 - 02:20 | 3280920 Nassim
Nassim's picture

Many years ago, I understood the following:

1- The internet was going to change things - I was on a predecessor of the internet at the time

2- Testing for conditions was going to move forward very fast - like electronics and not like finding cures

3- Pharmaceuticals would only marginally improve - and only at great expense. Now you can see that a lot of "new" drugs are no better than the ones that have come off patent.

I invented a way of handling the data for anonymous testing for transmissible diseases. It received its US patent. Afterwards, it was approved by the FDA as a "medical device". It is perfectly ethical and logical and very cheap - compared to the alternatives.

When drug companies steered away from it, I understood that the game was rigged and that sickcare is what it was all about - prevention stops them making money. Anyone who is interested may see the details here:

http://hivstatus.info

Wed, 02/27/2013 - 03:36 | 3280971 Lord Of Finance
Lord Of Finance's picture

Drug companies and insurance companies are slime. But the reason healthcare is a crisis in America is because there is a health crisis in America. Muti nation medical studies in Europe and Asia have confirmed that at least 90% of cancer and diseases are preventable through proper nutrition and excersize. I am not saying to go vegan and eat only organic. If Americans would just eat real food that nature provides regardless of how it is fertilized. Natural foods are the only way to go. Our high sodium take out breakfast,lunch and dinner lifestyle is what is killing us. We are made of water. Our cells need water and near full hydration at all times. If they do not get proper hydration/lubrication they become vulnerable to invasion from disease and cancer.

 

  There is no sodium in natures fruits and vegetables. When it becomes processed/frozen and shipped to the freezer or some restaurant, it is treated with preservatives that raise the sodium levels of the food by rediculous amounts. Sodium, whether it is a chemical or natural like salt, does only one thing to your body. It dehydrates it. Sodium dehydrates your cells too. If you are constantly eating processed or frozen foods or take out at virtually any restaurant, then you are eating food with way too high levels of sodium. If your cells are inundated with sodium, they are constantly fighting to stay hydrated, which over time weakens the cells thus inviting death to the cell.

 

You see. It is not just the high saturated fat content that is dangerous. Much more evidence is showing that way too much sodium is choking people off faster then fat consumption. Eat natures food. Also, many studies show a link between vitamin/dietary supplements and digestive cancers. Also, your body does not absorb the nutrients from suppliments. Most of the nutrients go out into the toilet. Your body does not know how to break down nutrients in a pill/powder or whatever the f#ck people take these days instead of real food. Remeber the old saying, "if it sounds too good to be true then it usually is". Well what do you think it says about supplements, especially vitamin pills. Yeah. Do you really think you can pop a pill and be able to get all your daily requirements for vitamins/minerals and phytochemicals???????????  Think again my friends.

 

  As for the importance of natural foods. Check out doctor Joel Fuhrman's, 'immunity solution' as it appeared on PBS. Yes to all of you conservatives out there. Me being one myself. PBS has a lot of great informational programming. It is not all liberal gibberish.

Wed, 02/27/2013 - 05:16 | 3281052 StychoKiller
StychoKiller's picture

NOT all vitamin pills are bogus: http://www.nutrilite.com/

Wed, 02/27/2013 - 13:28 | 3282251 Lord Of Finance
Lord Of Finance's picture

Incorrect. The AMA as well as multi-country wide studies in Europe and Asia confirmed that the bodies absorbtion of suppliments is around 15-20%.

   The truth is hard to admit when so many want to believe in the EASY way out when it comes to nutrition by ingesting a magic pill. 

   AND one more thing. How do you think your bodies very sensitive digestive system reacts to a full dose of all vitamins and minerals at once? The Asian andEuro studies link suppliments(vitamin pills, smoothies,and whatever the hell it is that people substitute for real food), to digestive cancers(pancreatic,intestinal,kidney and liver).

 

      You see. The food nature provides only has small percentages of minerals in it because your bodies sensitive digestive system can only handle a small percentage of mineral deposits at a time.

   When you take a fulll day supply at once. You are overloading the digestive organs with too much minerals and vitamins at once. The system becomes strained and winds up not processing/absorbing MOST of the nutrients. So not only are people wasting their time and money with these dietary drugs, they are also putting the digestive system,which is very sensitive, into overload.

    It is a matter of Newtons law. The same laws that apply to the universe also apply to us. The equal but OPPOSITE reaction of pills are dangerous side effects from liver,kidney/digestive problems or take the birth control OPPOSITE reaction. While it will stop the fertilization process, it will also greatly increase your odds of getting breast and uterine cancer. THIS IS AN UNDISPUTABLE FACT!! 

 

Wed, 02/27/2013 - 14:06 | 3282407 Lord Of Finance
Lord Of Finance's picture

Hey. I must add that I have considered health and nutrition to be a way of life for since I was 19. Back then I was taking suppliments until I was in my mid 20's. But even then I understood that I need food first. The supplements are just what their name implies.

 

   For example; Many people work part-time jobs to suppliment their income. But do they depend on that part-time job for their everyday daily needs and monthly bills? 

    It goes the same way with dietary supplimentd. If you take them, do not depend on them for your daily nutritional needs. I was a part-time suppliment user until I heard my local medical reporter, who is a doctor and a good egg, confirm that the AMA was finding their studies to be in agreement with the Asains that the body absorbtion rate of suppliments is extremely poor. This was some 10 years ago, and it took them until just 2 years ago to CONFIRM the results.

 

   As one Asian medical researcher put it. The AMA is always late to the party. But they are first to the funeral.

    Asian(both India and Orient) as well as European medical nutritional research is waaaaayyy ahead of us and that is also part of the problem. They need to get on the ball and research what is most important, and that is PROPER nutrition, but it does make sense that they do not do enough testing on the effectiveness of natural foods and the ineffectiveness of drug suppliments, since many of their funding comes from the drug companies themselves.

Wed, 02/27/2013 - 18:55 | 3282616 kshadow
kshadow's picture

Amazing, this must be the first thread on ZH i've seen where every poster has made a good point.  Being more solution oriented than ideological,  I went through a brief analysis of the healthcare industry and this is my opinion of a beginning solution.  Inefficiencies in the delivery of healthcare occur at every point in the system,  from misuse of medicare funds, to unisured patients, to insurance machinations, to lawsuits, to improper patient health, to systemic billing problems, to etc ad infinitum.  In order to have an efficient system as any engineer will tell you, you must first remove the superflous elements.  The best system i could define under this condition is the "NO BILLING CO-OP"  The system works like this a bit similar to an HMO.  The co-op is privately owned by the members with a say in all aspects.  Members pay a monthly fee based on operating costs of the facility.  There is no billing department or insurance company to haggle with wasting everyones time.  Patients make co-payment for visits and medication discouraging overuse but not discouraging important checkups.  Patients receive the care they need. cat scans etc. no charge, all components of the facility work on operating cost basis, not fee per use. Dental and eyecare can be included.  All staff including physicians paid on salary and not worked overtime.  CEO makes no more than 8 times what janitor makes.  Facilties need not buy most expensive equipment, but good will do.  In-house pharmacy who purchases in bulk, geneneric when possible.    If society wishes to provide coverage for uninsured, they pay same monthly rate as insured.  Uninsured limited to a small percentage of each co-op, say 10%, so they won't distort care quality and price structure.  Patient monthly cost is derived from health habits of patients to the ultimate quantity of care they wish to receive 

Anyway, this is the main gist of my proposal.  Costs could easily be reduced by 60% for similar or better quality care.  Currently 24 states have applied for Federal grant monies to start such programs.  Certainly,  they may choose different models but all will reduce the current costs.  This is the type of innovation that we need.  Other than that we may one day be stuck with Wal-Mart corporate clinics.

Wed, 02/27/2013 - 18:55 | 3283560 Lord Of Finance
Lord Of Finance's picture

totally agree. This was a good one. Even stychkiller responded with  my post by mentioning a better suppliment then what is out there. Maybe nutrillite can absorb into the body better. But that would require an isolated study on just one product and they could do it but wont. Maybe the overseas researchers will do it, but until then we have to assume that all suppliments have poor absorbtion quality and can damage the digestive system.

 

   Hey. I loved my suppliments. But I had to face the truth. I also loved eating take out. But just as well. I still eat out, but LESS often as before. I limit my takeout to about twice per month and concentrate on great natural food recipes, but I love good pizza like anybody so I devour about 1 pie a month. Then I go get some good Mexican take out about twice per month.

 

 Mexicans have one of the lowest cancer rates because their food is mostly natural ingrediants.

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