Asymmetric medical markets...

[toastedbread]

Maybe we can find some common ground here. From my experience today, this is an area clearly rip for price gouging.

A number of months ago I hurt my shoulder. (Partially torn rotator cuff I suspect) Finally I decided to do something about it last week. I spend around 1 hr waiting for the doc to tell me I need an MRI. So I have a $30 copay when in essence I could have simply gone directly to the MRI without wasting everyones tjme. Now this Tuesday I will again wait for him to examine the MRI which will take all of 5 minutes and pay another $30 copay.

Now I sit in the MRI waiting room. My deductible was raised from $250 to $500 at the start of this year. (Should have gotten my MRI last year. Oh well.)

I came to this facility because the docs office suggested it. (I'm sure they get a sweet kickback or smth)

Since I have insurance the MRI is only $464 out of pocket to meet my $500 deductible. That means the MRI total cost is only $464. How is one supposed to price shop? It could be $250 across the street for all I know. And this $464 is the discount rate they give the insurance company. These are not capitalist markets in the least.

Another issue I have noticed. .. I shadowed a cardiologist friend of mine to see if im remotely interested in medical school. The answer is no. Docs work waaayy too hard even for the $ they make. And he is making 500-600k per year. Anyhow, due to insurance and govt. Reporting absurdities he spends 20% of the time dealing with the patient and their issue. And frankly he just needs to see the scan and not even the patients. The other 80% of the time is spent filling in every reporting detail. I suggested he hire a transcribist to follow him in the office. This is what medicine has become. Paperwork.

 

[Marvin the Martian]

price shopping is hard

When I had cataract surgery I called places that friends recommended as cheaper than the local usual. The first question I was asked was what was my insurance. At that moment I know they typed it into their system and gave me the amount my insurance has contracted for. This is with a high deductible HSA plan.

Look up Castlight, it can help price shop in some cases.

I am sure we need to cut down paperwork. I always talk with my docs and one flat out told me that one major insurance carrier (that was hacked) is impossible to work with and requires far more than the rest. But in this market they dominate so they have to deal with them.

Honestly, front line healthcare should be a nurse practitioner. They can know enough to just forward you to a procedure/specialist, or treat what they can, or let you then see the GP. It would make everything far cheaper I believe.

 

[GOIU]

Why is it not capitalistic

To give a discount to someone who's basically buying in bulk? If someone could provide you a 1000 customers why would they pay the same rate as a single person?

 

[GOIU]

I find your last paragraph kind of contradictory

I see a nurse practitioner as my primary care, why would she refer me to a GP? That would be a waste, IMO, and she knows when to refer to a specialist. Now I would have no problem seeing a GP to start but she can pretty much do what they can.

 

[Marvin the Martian]

I don't know the laws

Can a practitioner prescribe narcotics, for example? Are there any conditions a GP would have more knowledge of? Normally I look things up but I am posting during timeouts at the IU women's game.

 

[zeke4ahs]

You might want to shadow a teacher

And see how hard they work to make about a tenth of that. And many other professions, I'm sure too. The mountain of paper work is a problem in teaching too, and getting more so every year.

 

[toastedbread]

Ok, I never said it's the hardest job in the entire world...

But I wouldn't face his task each day no matter the compensation. I deal with schools on a daily basis. Nothing is worse than dealing nutty parents who think their kid is a god, and every second kid who has ADHD. However, teachers still have weekends and summer breaks.

 

[toastedbread]

I never said that wasn't.

Although some of us do confuse competition and capitalism. Capitalism actually requires some level of regulation or else we end up with monopolies.

My issue is with the asymmetric info available to consumers which imo is designed to prevent competition and fair pricing. The scheme is intentionally complex and convoluted.

 

[zeke4ahs]

Just giving you a hard time

But not always , especially the weekend. I'd usually go in at least one weekend day and had workshops and meetings summers too. But getting paid 500,000 would help!

 

[SuperHoosierFan]

Um, yeah. . .

I spend at least 70% of my time charting what I did with the other 30%. Ever since everyone went lawsuit happy over the years, we all (doctors, nurses, techs, therapists) have to double, triple, and quadruple chart all the shit we do. Give one medication and you have three different places you have to chart that you gave it. It's ridiculous. Miss one little thing with charting and you leave yourself wide open to get your ass handed to you if you ever end up in court over something. Unfortunately, this has lead to a lot of falsified charting. Medical workers have been told over the years "If you didn't chart it, it didn't happen", even if you did it. Well, a lot of medical workers have figured out that the reverse is also true "If you chart it, it happened", even if you didn't do it. Nursing homes are the worst when it comes to this. One nurse and two aids simply don't have time to do everything needed for 20+ patients who require total care. I can tell you from past experience that that's about the ratio you get. It's worse in the for profit nursing homes. Minimal staff with maximum patients = money for the owners and shitty care for the residents.

 

[meridian]

Yes, it is obscene.

Last year I fell in a YMCA gym and slit my year. W/O going into the details, the final cost was $85,000, involving the emergency room, plastic surgeon, nurses, hospital, and "10" other parties.. I had an occasion to visit Group Health later, and told the doctor about horror story. He said he could've done the whole thing for $500~1000.

BTW, I didn't pay the bill. It was split between the YMCA insurance and Group Health.

 

[GOIU]

Yes you did

These are not capitalist markets in the least.

Maybe I misunderstood that statement.

 

[GOIU]

Good question

I believe they can unlike a physicians assistant, but I haven't had that issue. I do know that a NP usually is in a group with internal medicine or GP and they can sign off on any scripts without seeing the person.

 

[toastedbread]

I'm referring to the lack of available and clear pricing info.

Pretty obvious.

This post was edited on 2/6 12:49 AM by toastedbread

 

[DougS]

TFO totally agrees with you

You have acquired a powerful ally.

 

[Marvin the Martian]

I will add a medical rant

I have apnea, and thus use a CPAP. In order to buy a CPAP one must have a prescription which usually means having a very expensive sleep study.

Why? Sure, there is an ever present risk that teens will get hooked on CPAPs at a young age. Getting them to go to CPAP anonymous is tough. And having to deal with professional athletes using performance enhancing CPAPs will be a major issue for sports leagues. I get that, but can't we risk it if it saves costs?

But here is the reason for my complaint. It is not just the CPAP that requires a prescription. My CPAP humidifier is a separate unit that connects to the CPAP. It is broken. The online cost is far cheaper than my local provider for a new humidifier. And probably only slightly more expensive than a repair. But to get it I need a prescription. I can call my doc and stop by and get it, but why? Is there really a risk people are buying CPAP HUMIDIFIER'S illicitly?

Similarly, the masks can be bought with a prescrption. But without one has to buy the components and assemble one's self. Thank goodness, I can sleep knowing 14 year olds find it difficult to buy a fully assembled CPAP mask to get hooked on.

 

[Mas-sa-suta]

You're a smart guy...

...can you see the opportunity to develop a method to determine costs of procedures, etc., and build a business to make that information available to consumers?

That would be entrepreneurship and capitalism...

And you could become even more wealthy than you are now....

 

[Sope Creek]

Been there, done that . . .

and the problem isn't the system to organize and present the data. It's that (a) no one has any incentive to provide their pricing data for public display, and (b) insurance contracts distort health care providers' pricing so much that the data that might be available would end up being largely useless to most users.

Today, the only information that really has any impact is the price negotiated by the insurer for the plan you're under . . . and if you don't have a plan, then the only information you need is what you can negotiate, if you have the time to do the investigation and analysis before you have the medical procedure done. For most folks that's an untenable result.

I've advocated on this board simply requiring all providers to make all of their service rates public, for each insurance company they accept and general "retail" pricing. This would be the first step toward a true market economy - in the way Adam Smith envisioned it - in the health care industry. But pricing is among the most difficult information to get.

 

[i'vegotwinners]

Re: Been there, done that . . .

Originally posted by Sope Creek:
and the problem isn't the system to organize and present the data. It's that (a) no one has any incentive to provide their pricing data for public display, and (b) insurance contracts distort health care providers' pricing so much that the data that might be available would end up being largely useless to most users.

Today, the only information that really has any impact is the price negotiated by the insurer for the plan you're under . . . and if you don't have a plan, then the only information you need is what you can negotiate, if you have the time to do the investigation and analysis before you have the medical procedure done. For most folks that's an untenable result.

I've advocated on this board simply requiring all providers to make all of their service rates public, for each insurance company they accept and general "retail" pricing. This would be the first step toward a true market economy - in the way Adam Smith envisioned it - in the health care industry. But pricing is among the most difficult information to get.

in the "kicking the can down the road" dept, that's all any discussion on the best way to introduce full disclosure in pricing is, in some absurd attempt to try and correct the problem of costs through competition.

there is no way to ever introduce comparative pricing on far too many things relative to healthcare, and there never will be.

example,

you call General Hosp for a price on a triple bypass, including doctor's fee.

they quote you $299.95 (with coupon in Reach Magazine).

you need one, that's a great price, you get admitted to GH for the procedure

upon checking out of GH, you are handed a bill for $183,000. (they've already dinged all your credit cards up to the limit of every card).

you say wtf, you quoted me a price of $299.99, including primary surgeon's fee.

they say yes, that is what you were charged for the procedure and surgeon.



then there was the hospital admittance fee,

credit check fee,

transport to room fee,

transport from room fee,

room fee,

room prep free,

administrative fee for room prep,

prep fee

prep for prep fee,

prep for transport fee,

licencing fee for every tool used in the procedure.

anesthesiologist fee,

anesthesiology prep fee,

separate monitoring fee, for every separate monitoring you got.

post op prep fee,

post op fee,

more transport fees,

administrative fee,

administrative fee for prep,

administrative free for post op.

activation fee for every monitor,

etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc,

and you end up with a 50 page bill of itemized expenses written in a foreign language, totaling $183,000.

and a note at the bottom saying, "you saved $91,000 with your Reach coupon".



no matter how hard one works to pin them down on price, they will find a workaround for whatever price they quote you..

and how do get a price quote on anything that you don't know you're going to be charged for going in.

and they can get around full disclosure on any procedure, not just something complicated like triple bypass.


if you try to pin them down on a bottom line cost going in, they will say that's impossible.

but they will be more than glad to quote you a price for any specific item.





even if you had an army of lawyers and consultants working for you, you still wouldn't be able to ever pin them down on final cost.

and what if you don't have your own army of consultants and lawyers, and don't have 2 yrs lead time to fully investigate every time you need fixing?




these people that think we can somehow fix the problem with competitive markets, or cost comparisons, are just totally brain dead as to what and who we're dealing with..







This post was edited on 2/8 12:10 AM by i'vegotwinners

 

[i'vegotwinners]

Re: Why is it not capitalistic

Originally posted by GOIU:
To give a discount to someone who's basically buying in bulk? If someone could provide you a 1000 customers why would they pay the same rate as a single person?

that statement is so misguided, it's beyond belief.

first off, they aren't providing anyone with 1000 customers to begin with.


the reason ins carriers get cheaper rates, is because they pay in bulk, not buy in bulk.

they are not one entity that buys 10 millions units.

they are representation for 10 million entities that buy 1 unit each.


those cheaper rates have zero to do with economies of scale, or bringing in extra business, but rather with the negotiating power of "representing" in bulk.

representing separate individual buyers in bulk, (not the same as one entity buying in bulk), gives them negotiating power to essentially price regulate.


while some don't like the term "price regulation", that's what it is.

that's what medicare and medicaid do as well. they regulate price.



that said, it costs no more for a caregiver to treat someone uninsured, than someone insured.

for caregivers to charge the uninsured more than the insured is an absolute abomination, and an indictment of both our court and legislative branches who allow it.


the very reason a 1 payer system serves the citizenry best, is because it can price regulate the best.

and in a system like healthcare, which both is required by all on literally a life or death level, and literally impossible to introduce true market competition as a check on costs, price regulation becomes a must.

the price is regulated now, for all but the uninsured, so don't give any BS about we don't need price regulation.

the healthcare industrial complex is immune from the market forces that dictate price in competitive mkts with low barriers to entry..

thinking we can operate healthcare absent price regulation, is insanity.

as is believing the uninsured shouldn't be covered by the same price regulation controls that cover everyone else.