Translation is literally: we have no idea if we can fix the damage this will do

i'll pour one for you..carry on

Saw a tweet about how McCain doesn't care now because he's not running for anything again so he can do what he really wants and apparently he really wants to make life difficult for a lot of people.

Like other people with brain cancer I suppose.

That's pretty solid information, and the cusp of the problem.

US healthcare is shit.

He's oversimplifying to the point of deception. Is that common in his videos?

Here's where he's wrong:

1. If you don't pay using insurance, in most states (except in a handful of red states where legislation allows otherwise) you don't pay the inflated prices. If you're poor, you get "charged" the inflated prices and then forgiven nearly all of it through various methods. My step son didn't have insurance when he was in his accident, and his total bills were over $100,000, but he (we) only paid $8,000 at the end of the day. They literally had an expense forgiveness person in this South Dakota regional dumphouse, whose job was to protect him from financial ruin by...the hospital. We have an entire team of them at the children's hospital.

If you DO have enough money to bypass insurance and pay direct, you pay a fraction of what the cost would have been. I've done this a few times in my life, but my dad used to do it all the time. He owned a security business of around 100 employees and his wife was a hypochondriac. To avoid her issues affecting his company insurance costs, he'd pay out of pocket even for procedures, at a reduced charge.

2. Most hospitals struggle. Don't laugh. Research has actually shown that the two primary factors in why American hospitals (which, as organizations, do not average astronomical profits...although some [usually rural southern] hospitals do ) costs more to run than hospitals in other nations were:

2a. CEO and other top position pay. The whole "we need to attract the best talent" logic that has everybody trying to compete and outbank each other. American hospital top management expenses are absurd.

2b. "Safety," or what some call case-building testing. This is when the doctor knows what is wrong with you, but orders labs etc anyway because they don't want to get sued later. They know what the problem is, but if they don't have hard evidence and you sue them later, it can be expensive or ruinous. So you get to pay for their self-preservation. Doctors in the US face more litigation than anywhere else in the world.

Case in point, doctors in the US order twice as many MRI's as in other countries, but our diagnostic success rate is about equal to other developed nations...because the MRI was only done to build his/her defense case.

So about that claim I made that most hospitals struggle, and the exceptions tend to be in states with Republican legislative bodies...

"2a. CEO and other top position pay. The whole "we need to attract the best talent" logic that has everybody trying to compete and outbank each other. American hospital top management expenses are absurd."

Preach. Though this is a problem across the board.

You're right that most health groups will give you some kind of a break if you can't use insurance but it's not always the case. and there's no way to be sure that the Hospital won't use an "out of network" provider during a procedure like a surgery because it's the surgeon's call who he uses and we get stuck with the bill and months of appeals later.

It is absurd that an industry that is so important as healthcare gets to obsure virtually everything they do in pricing and then blame the consumer for "not shopping around"


At least in my state (Georgia) our urban hospitals were struggling (doing better now but executive compensation is always a problem) because they treat a great number of poor people and of course we did not expand medicaid under the ACA. Consolidation of health groups has mostly led to a closing of rural hospitals and providers making it fairly dangerous to live outside of a major metropolitan area.

What we probably need at this point is another Teddy Roosevelt to come along.

My wife has just corrected me. The bills for the accident actually amounted to over $300,000 (he was in hospital for many months) and, in fact, he paid none of it. The $8,000 I was remembering was for some equipment I bought him out of pocket when he left the hospital.

Doesn't that sort of beg the question as to whether being part of some insurance group is actually necessary?

Instead of an insurance company negociating the price it was negotiated at the personnel level correct? Because $300,000 is a really nice house in some areas of the country and $8,000 was a reasonable sum that actually could be paid.

Why is it so hard to get there with medical billing for everything? The entire system is inflated at each stage.

The "out of network" deal is a mess, and nobody's happy about it. It's basically a three-way battle for control of who gets to make billing decisions between the insurance companies, ASC's, and physicians, and we get caught up in it. However, again, some states have laws that limit the circumstances and responses to this, and others don't.

Basically, we should be looking to the south to see what a GOP healthcare system looks like: organizations generating massive profits even in poor, rural areas, but protected enough from regulation that the quality of care provided is a roll of the dice.

I agree with McP. When I was 20 I was uninsured and had to have surgery. The bills for everything came to about $45,000. I paid $2. Literally $2. They have a lot of programs for low income/uninsured patients. In fact, my wife works there now and says that the bigger issue is that self-pay is quite often cheaper than the prices many people with insurance actually have to pay out of pocket, but if you are insured the hospital can not legally charge you as a self-pay customer, they must go through your insurance. There are a ton of really bad insurance policies out there, with high premiums, high deductibles, high coinsurance, etc.

In my opinion, the two biggest factors for high healthcare costs are (1) the insurance industry, and (2) over testing/diagnosing out of fear of litigation. McP already talked about the 2nd one, but I don't think it can be overstated how big a problem over testing is. For one thing, it greatly increases the demand for these tests, etc., increasing the costs of those machines, tests, and services, but it also leads to much higher incidences of false positives, and over treatment of problems that while not false positives because the person does have the diagnosed condition, had it not been tested for and discovered would not have been noticed or affected the person's quality of life. This again further increases the demand for medical services, increasing the prices.

But this 2nd problem (aside from the threat of litigation) is really a symptom of the 1st. Having insurance greatly changes the incentives of people when it comes to the quantity of healthcare they are going to purchase. For example, consider a person who is coming down with something that feels like a head cold. If this person is insured, they've been paying a premium for months or years and only "benefit" from this investment when they actually receive discounted medical care. Their co-pay to see their primary physician is $20 and the co-pay for the antibiotics is another $10, let's say. Compared to the amount they've spent on insurance premiums (and no care, so far this year), the additional $30 seems like very little. So the person is incentivized to take advantage of this low additional cost and go to the doctor and get a prescription. If the person did not have insurance, and therefore had not paid those premiums, and would now be responsible for the full cost of the doctor's visit and prescription, the higher current cost would likely incentivize him or her to perhaps try to avoid going to the doctor unless it was actually necessary. This has a major effect on the demand for healthcare services, and Americans likely demand a much greater quantity of healthcare than is optimal, and in my opinion it largely has to do with how we pay for insurance and how it changes our incentives.

Captured it better than I.

Nobody knew healthcare could be so complicated.

lol



Mrs. McP: "Hey, honey, I was RMing earlier and saw that you quoted $100,000 for Jr.'s medical bills; it was actually $300,000."
McP: "You were RMing?"
Mrs. McP: "I'm Dev, honey. I was just waiting for the right time to tell you. I'm Dev."

McP:

Spoiler: show

oh god

I cheated and drank exactly that all last night.

I'm still pretty displeased that prescription drug advertising is a thing. Really, getting rid of "co-pays" and opening up the HSA model to save for those types of expenditures is probably not a bad idea.

I was thinking this morning how much I dislike the "generic" term for drugs. It just makes them sound like they're not as strong or something and that combined with the advertising makes people say, "No, I don't want that cheaper one." or even "I want the one I saw on tv."