Medical costs (rant)

[germdoc]

2 months or so ago I had a few blood tests which a guy of my age should have, including a lipid panel, PSA, etc. Total cost of 5 tests: $500, of which I'm responsible for $350. A blood sugar was $80, PSA was $150, etc.

My daughter broke her arm about a month ago, and I got the bill today. $2400, including $1000 for "surgery" (putting on a fiberglass cast, which took literally 10 minutes), of which insurance apparently covers NOTHING.

I am really ticked off at #1 the cost of health care and #2 the fact that my health insurance, which should be among the best around, covers so little, especially after I pay $10,000 or so a year in premiums.

As a doctor I should feel responsible for this, but I don't (or at least only a little) because I personally see only a small fraction of the money my patients get charged, and I have zero say in how charges are determined. Procedures and tests generate the lion's share of the revenue, while "brain work", which I do, is much less lucrative. (The ER doc that diagnosed my daughter's broken arm got only $200.) Of course the majority (about 85%) of the payment goes to overhead, HMO costs, taxes, and to make up for patients who can't or won't pay bills or who have Medicare or Medicaid which don't cover the costs of care (this is called "cost-shifting"). And computers. And fancy new buildings. And heating and cooling costs. And taxes.

I feel a great sympathy for patients who have devastating illnesses and less-than-adequate coverage. I do try to practice cost-efficient medicine as much as possible, and I hope this makes a little difference.

However, I'm telling you boys and girls, we have a problem in this country. If you think we can continue down this road until 2050, when some of us go into the nursing home with advanced dementia at age 98, you are crazy. There is a crisis looming in the not-too-distant future, and it will be ugly. We will be lucky if we have any health care at all at any price.

[MilDoc]

When I had my intra-aortic stent put in, in May, for an abdominal aneurysm, the total hospital / surgeon charges were $62,000+.

My insurance paid $11,000+, FULL PAYMENT. I owed nothing additional. Had I NOT had insurance (yearly fee: $5400 just to cover me, not LOML + $2,000 deductible + co-pays, etc), I'd be looking at bankruptcy.

Most folks have no idea what a totally corrupt, ridiculous system we have in this country. Where the CEO of United Health Care received over $167,000,000 in total compensation for ONE year.

I'm old enough to remember the "golden age of medicine," when hospitals, insurance companies, etc were non-profit. Then Wall Street took over and most are now "for profit.' And well over $100,000,000,000 a year gets siphoned off for profit, salaries, etc etc etc.

The system is about to collapse. This country spends 2-3 TIMES what other countries do for health care. Yet, we have WORSE health statistics. We NEED a National health Insurance program, which is NOT "socialism," despite what its naysayers like to claim.

And you, germdoc, need a better health ins. co.

BTW, Mods, this may seem a "little" political," but it affects everyone. Not quite as political as saying which candidate you like, etc etc etc. These are decisions that will eventually affect everyone here.

[Kristofor]

Not holding my breath on this thread staying non-political...

In 2006 medical spending accounted for ~16.6% of GDP, or about $2.2 trillion. Using $100 billion in profit as the number (no clue if that's low or high) that would account for ~4.5% of the cost, which if accurate seems pretty reasonable...

There was an interesting segment on NPR on the way home from work talking about the economy in general and comparing the misery index (inflation + unemployment) from the 70s/80s to today (still much lower). But the gist of the segment was that medical costs are the wild card hanging over everyone.

One of the interesting stats they threw out is that general inflation has caused average prices to increase to 3x what they were in 1980, but the cost of medical care has gone up to 5x, and worse insurance has gone up to 10x the cost in 1980. For actual costs going up a little less than twice the rate of general inflation that actually seems like a fair number considering all of the new technology, testing, drugs, and diagnostics involved... But the insurance being so much higher is clearly a huge problem (especially since you pay the BS overstated rates when you're actually paying for medical services with cash...)

As for the original post, I guess we need to decide what the benefit of a given test is before you can decide if it's a good deal... Would you pay $500/yr every year of your life for 3 years of bonus life expectancy?

Nobody did genetic screens 10 years ago, nobody did full lipid panels or PSA tests 30 years ago, nobody did transplants, dialysis, insulin injections, or joint replacements 50 years ago, nobody did antibiotics 70 years ago, and on and on. There are some added costs for this new technology but the vast majority of the costs are on the provider side. The actual cost for the PSA test was just a very small percentage of that $150...

[cgallery]

...(especially since you pay the BS overstated rates when you're actually paying for medical services with cash...)

That seems like something we really need to do something about. I'd forgo health insurance on myself if I were guaranteed that I'd pay the lowest negotiated rate.

[JR]

Oh boy, is this a topic I think about a lot!

As I understand it, if there were standard data interchange formats, along with standardized terminology for procedures, there could be $Billions in savings.

I'm not necessarily against the one-provider thing, though I lean more toward the mandatory coverage/multiple provider thing happening in Mass. (+Vermont?). Mass. members please chime in as the effectiveness of the program in that state.

I remember in the Presidential debates eight years ago, one of the candidates (it doesn't really matter which one, or from which party) suggested that mal-practice insurance was the big culprit. He said that doctors were ordering extra tests as a pre-emptive move against mal-practice suits, and that was what was driving costs up. I thought that missed the mark, given the millions of people who can't get test - either because they are uninsured, or their HMO won't allow it.

JR

[just started]

I am 'retired' at no wish of my own but not yet old enough for Medicare, so I'm forced to get Blue Crooks/Blue Gotcha as an individual subscriber instead of in a group plan. In the ~6 years I have been a subscriber my monthly payment has gone from ~$360/month up to (starting 1 Sep. I got notified today) $1200/month. When I was still working and had insurance for which I paid 25% of the cost the payroll deduction was ~$35/month for the same coverage with BC/BS, with the exception that under the plan at work I could order my meds from their mail-order pharmacy for a 90 day supply @ $5. for generic and $30. for brand-name. Now I have to go to a local pharmacy and pay full price for no more than 30 days supply and BC will reimburse me 50% eventually.

The other thing that drives me crazy is the multipule level of charges for the same test or procedure. This bulls**t about 'negotiated' charges needs to be done away with. Any 1 test costs the same no matter if an insurance co., medicare or an individual is paying the bill and the charge should be the same!

[Uncle Cracker]

I feel your pain, guys... My United Healthcare group policy premiums just for me are $12,000 per year! Add to that the average of $3,000 per year I still have to pay in co-pays, and my out-of-pocket cost for "peace of mind" is $15K annually. And if I had family coverage with dependents, my annual premium would be $43K!!! How can any working person afford this? And I see no hesitation on the part of any component of the system, be it insurer, physicians or facilities, that misses any opportunity to pad their revenues any way possible within the system (such as my PC physician having his lab techs take vitals when I have blood drawn, so they can charge UHC for an office visit, and collect another co-pay from me). It's a death spiral. Something has to be done...

[pierhogunn]

Just Like Taxes and any other hidden thing that we pay, the price of stuff always goes up when you can't easily see what you are actually paying.

Insurance can be so expensive cause you only pay for a little of it each month on the "front-end" of your pay.

Imagine how things would be different if you:

Got your full paycheck each pay period, and then had to pay your bills/taxes/insurance from that

or if, when you paid for gas, the only price you saw on the pump was the price that the gas station was charging and not the extra taxes on the gallons...

By shifting the payment for these necessary things, we have allowed ourselves to be duped into paying significantly more that we would if everything were a direct payment

[sparkeyjames]

Hospitals are the most grossly over charging business there is on the planet. When you hear stories that they charge $25 for a single extra strength Tylenol pill or $100 for a simple bandage pad plus tape, you know there is an incredible amount of gouging going on. Trouble is no one seems to be able to do anything about it.

I have been having trouble with a hiatal hernia (stomach is partially up through the diaphram) and the pain is so intense sometimes it feels like a heart attack. The pain is almost to the point of being debilitating. One time I came close to smashing my car because I almost passed out due to the pain. I have taken at least 10 days off work so far this year because I could not function. 3 trips to the emergency room in the last year and half have put me down $3500 out of pocket. I have had to take out loans to afford to pay the bills. The insurance company will not allow the surgery to correct this. On top of that I have to buy lots of antacid tablets, pain pills, and a scrip for a digestive system relaxant. They are costing me and my employer plenty because they refuse to allow the surgery. This would put me out of work for about 3 to 6 weeks or so but would cut all costs over the next XX years to next to nothing.

Hospitals have raised the prices to the point that without any kind of health care insurance a trip to the hostpital will put a person into immediate bankruptcy. Or they could just not pay the bill and of course the Big Hospital Corp gets to write that off as an uncollectable. This of course depends on your financial state. If you make too much BHC will come after your pay. If you don't make much they are more likely to write it off.

[germdoc]

These are all interesting comments. I actually don't have a solution to the problem, except that we need to accept limits in the care we provide and receive. E.g., giving chemotherapy to 75 y.o.'s with lung cancer or dialysis to 80 y.o.'s (I see this happen all the time) is probably unreasonable.

The point of my rant is that costs are not transparent or reasonable. I had no idea how much I would be charged for these tests or doctor's visits up front. I had no idea how much insurance would actually pay. (We are a NFP clinic/hospital, and I am covered under their HMO plan.) I really don't think these costs are supportable--I mean, $550 for tests that every guy in late 40's needs? $2500 to treat a fracture that literally would heal itself if we did NOTHING but put an Ace bandage around it?

And Paul I don't know if your stent was "worth" it, but I do know that you could just about get a new kidney for that price. I'm curious if they gave you an estimate of costs up front...

[pierhogunn]

I just hope that we never get to a point in this world where a trip to the hospital, or the doctors office includes you bringing a list of your assets and sitting down with an auditor prior to the commencement of your care

[dlminehart]

This is, in fact, a political problem, and not a partisan one. Congresses red and blue have had ample opportunity to address this issue, but our electoral system has them all looking out for where their election campaign contributions are coming from, and where they'll work if they ever leave office.

I'm not too optimistic about the Massachusetts "compulsory private insurance" model. While they tout the increase in people who have insurance, I also hear that doctors are free to reject patients with this coverage. People are driving 50 miles to find someone who'll see them, turning to emergency rooms, or being forced to continue going without medical attention.

In short, simply making it mandatory to buy into the existing system, even with taxpayer-subsidized help for the needy, without a requirement that medical care actually be provided could well be a case of pushing with a rope. But, given that it seems to give us constituents "coverage" while reassuring the existing drug/insurance/medical complex that they can still call the shots, it seems the most likely "solution" our politicians will embrace.

[docrowan]

I agree with germdoc's comment about not knowing the price up front. When I have a car repair I get an estimate upfront and expect the final bill to be close to that. If it's not, I probably will not do business with that repair shop anymore. Another thing is if something is wrong with the repair, I expect the shop to fix it at no charge or explain to me why the second repair is unrelated. What we really need is to get the medical system closer to this kind of billing practices. As it stands right now, many times the doctor has little idea what the tests he prescribes cost. I don't have an answer, but I know most of the medical bills I receive for my mostly very healthy family are a complete mystery to me. One itemized bill with standard terminology for each "episode" or even each visit would go a long way to making this process more transparent.

I should say I am not a doctor of any kind. I picked up the nickname in school because I liked to read encyclopedias.

[182much]

health care

I just watched the Mike Moore film called "Sicko"
I couldn't believe the BS insurance/drug companies pull off.
Off course the govt helps in this process too

[germdoc]

Update: I found out my insurer has not processed claim re' may daughter's fractured arm because they need some specific information about the accident, i.e., whether it's someone else's fault or not. (If I sued school where it happened, they could deduct their responsibility from any money I received.)

Looks like most of it will be covered, except for copays, deductible, etc.

My point about excessive costs of care still remains valid however. X-rays alone were over $1000, cost of putting on cast was over $1000.