You can look it up, along with tens of thousands of other goods and services.
Before you look, what do you want to bet that the price has gone up 10 fold relative to the price of the plastic that's in it...over the last 20 years?
Trump tells House Republicans to find a ‘fair number’ on SALT
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Before you look, what do you want to bet that the price has gone up 10 fold relative to the price of the plastic that's in it...over the last 20 years?
How much has the price for a DME provider to purchase increased?
How much does it cost to be a Medicare DME provider?
How much has that increased over the last 12 years?
Why does the price of fertilizer increase when the price of corn increases?
Good points. We all know that rural hospitals across the country are struggling. And Vermont is very rural. We visited in 23, I was amazed how small Montpelier is. The article below makes an interesting point, "'In most cases, the amounts these private plans pay, not Medicare or Medicaid payments, determine whether a rural hospital loses money,' the report’s authors wrote. "
More than 700 rural hospitals at risk of closing: report
One challenge hospitals face is reimbursement from private payers, which doesn’t cover the higher costs of care in rural areas, according to a report by the Center for Healthcare Quality and Payment Reform.
The corporate tax rate should be left where it is. The 21% rate is globally competitive. And that doesn't take into account things like R&D credits.
Yes, there are lower rates in other places. That OECD benchmark is 15% -- and I don't think it's hard to justify a 6% premium to operate here. The 35% rate we had before the TCJA was counterproductive. But we're well within line now.
Also, they're going to have to figure out ways to increase federal tax revenues.
Yes. You get it!!! That is the exact crux of the problem. I will try and follow up asap.
Well, things that aren't scarce.
Look at the obvious ones -- speech, exercise of religion, assembly, association, due process, equal protection of laws, voting, redress of grievances, etc. None of those things are constrained by limits of supply.
How all the other 330 million Americans choose to use their right to exercise religion has no bearing on my ability to do the same. If everybody else in my town engages in religious ritual of one kind or another every day, that doesn't restrict me in how I use my right of free exercise of religion.
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Vermont has always been rural. And it's always been shaped as it's shaped.Good points. We all know that rural hospitals across the country are struggling. And Vermont is very rural. We visited in 23, I was amazed how small Montpelier is. The article below makes an interesting point, "'In most cases, the amounts these private plans pay, not Medicare or Medicaid payments, determine whether a rural hospital loses money,' the report’s authors wrote. "
More than 700 rural hospitals at risk of closing: report
One challenge hospitals face is reimbursement from private payers, which doesn’t cover the higher costs of care in rural areas, according to a report by the Center for Healthcare Quality and Payment Reform.www.healthcaredive.com
Vermont has not always had the majority of their hospitals going broke, their largest insurer going broke, fully insured patients unable to access services, etc.
Again, I get why everybody rejects what I'm saying. I knew you guys would -- just like the experts scratching their heads. I'm used to it. Nobody likes cold water poured on them. And people are just bound and determined to make the fairytale come true....so they are naturally going to scoff at anybody calling the fairytale a fairytale.
If you looked at my link, there are 80 rural hospitals in Texas going broke. What state laws caused that? Kansas has 62. Neither are at all liberal states, neither have anything close to universal coverage.
The entire healthcare finance paradigm is a disaster, Marvin. Rural hospitals around here are going broke, too. It all started going haywire in the early 70s as government got more and more involved in healthcare. And their involvement has only increased since then.
Vermont isn't unique -- they're just in a worse place than most other states...because they've been making a more concerted effort to find the unicorn.
The first step to fixing the problem is abandoning the economically impossible idea that healthcare is a right. That's not a matter of choice -- it's a matter of the limits of economic possibility. Only when we do that will we be able to start turning the ship. And it will have to involve getting consumers properly situated. Move away from using insurance to pay for ~80% of our healthcare dollars. Give consumers the information and the incentive they need to be frugal.
What are the reimbursement rates?
Real dollars?
Compared to costs?
Why are the big pharmacies buying PBMs?
I'll tap the sign again. You may not be a big fan of Sowell's. But can you make an argument that he's wrong here?
Vermont isn’t unique. Most of the land in the country is rural and population non-dense. So does your vision see a scenario other than every single state having to subsidize rural hospitals and providers to ensure rural citizens have access to care?
What we're doing here is the regional hospital buying up the struggling rurals, cutting their operating costs by assuming the backoffice tasks (scheduling, billing, EMR, HR, etc.) and eliminating the more expensive services offered at the rurals -- using them essentially as frontline clinics that utilize referrals to the regional centers for specialized and higher-end services.
Why is the price of plastic the litmus test? Materials is only one part of materials, labor and overhead. Labor and overhead will always be the drivers of cost in commodity products.
I didn’t read the link but I would wager that those hospitals are going broke due to having outsized shares of Medicare and Medicaid patients.
I'm actually hauling corn today, so if you would like to expand on your thoughts, or give your opinion, please do.
I'm sure that's part of it.
Again, I saw the data on the hospital I'm affiliated with -- breaking down P&L for private insurance, direct pay, and public insurance. It was Pareto Principle city.
I'd guess that any healthcare institution that's heavily reliant on public insurance is sucking wind. That's the reason I think attacking this simply by curving down reimbursement rates is almost certain to lead to negative unintended consequences.
There isn’t much to add. Until people see the true acquisition cost, until they see the contracted reimbursement rates. Then they can get an idea of what the provider is making. That’s a start.
Then you have to delve into the artificial increase in the cost to the consumer because of third party involvement. Make no mistake….these are artificial increases. Without PBMs and insurance coverage the costs would be drastically lower.
Now….I do think we need coverage for the high ticket items…surgeries, hospital stays and the like. We also need coverage for the patients that are truly physical and mentally disabled….that number should be drastically lower than it is now…
I’ve been out of the Medicare billing game for over a decade but I that time they had started to charge an exuberant fee to be a provider. It was asinine if the goal was lower coverage for more folks.
It’s a bad system where everyone is looking to put their stamp on it to “improve” it.
Remove the vast majority of third party involvement…presto
Most advanced nations have healthcare as a right, so the unicorn exists. We spend more per person and per GDP than the UK, Germany, France, and Canada.
Then we get into the "well, they have to wait". So do we. If I wake up ill on Tuesday I can't possibly get in to my PCP. IU Health has a "walk-in "clinic, and if I am online by 7 I have a good shot at getting in that day. I quoted walk-in because it is tough to get in by walking in, one needs to schedule. Same for the west side non-IU "walk-in". Now some days are better, looking at the schedule for today, the save a spot in Bloomington is full for today.
If you injure yourself playing basketball at noon, the chances of someone in Bloomington getting you in that day are small. I am sure somewhere there is a private practice that might have room.
My wife's knee replacement had to be scheduled many weeks out because Bloomington's IU hospital lacked enough beds, and she had some risk factors that made it best to stay overnight. There were stories in the paper of overcrowding, ER patients spending nights on gurneys in hallways. Bloomington isn't huge, but it isn't totally rural either.
Five of the 11 IU walk-in clinics have waits of over 2 hours. I know from past experience that means there is a chance they actually will not get to someone if they came in now as that 2-hour wait is wildly optimistic given they have a lower priority than the people who scheduled and the schedules are full/mostly full. Heck, I've waited 2 hours while on the scheduled list.
There are trade-offs. Somehow though other countries pay less and have fairly universal care. And there wait times may be worse, I don't know how to really compare that. But we certainly have wait times.
Your issue with being unable to be seen is a market forces issue and seems that there would be a major opportunity for new clinics to pop up in Bloomington.
If any of the aforementioned things happened to me, and I live 5 miles from a major metro, I guarantee I can be seen that same day. Don’t confuse a shitty environment for being normal.
I linked the listing of IU Health, it is more than Bloomington. And it is national. see link below. We have a shortage of PCPs and it is getting worse. If we are short doctors, how can we have adequate service?
'No one can see you now': Primary care in crisis amid physician shortage, underfunding
A new report shows that a physician shortage and lack of investment in primary care has caused Americans' average life expectancy to decline.
healthjournalism.org
Below is a story from another link about Florida:
My personal experience with the PCP shortage has made me keenly aware of its consequences for individual patients. My wife (a physician and retired managed care executive) and I were lucky enough to acquire a second home in Florida for the winter months. Being familiar with the idiosyncrasies of healthcare system and adequately insured, we embarked on a search for a primary care doctor who was trained in the U.S., had admitting privileges at a quality hospital, and accepted new patients.
Even with both of us doing the research, it took a year to find one – the most junior partner (younger than our children) in a practice that had no online presence and communicated solely by phone. The only alternative was a concierge practice at $5,000 per person annually!
Opinion | Supply Chain Problem for Primary Care
Action is needed to prevent a looming physician shortage
www.medpagetoday.com
Georgia is spending $50 million to add another medical school because the problems there are acute.
Federal data shows a nationwide primary care shortage. Here’s how Georgia fares.
As Georgia is preparing to fund construction of a new medical school with the hope of solving a shortage of doctors, the federal government has been tracking areas with primary care provider shortages for decades.
So I’m confused then - many of the good liberals say on this board that too-high physician salaries are why costs are so high. If that’s the case, then why is there a shortage in some areas?I linked the listing of IU Health, it is more than Bloomington. And it is national. see link below. We have a shortage of PCPs and it is getting worse. If we are short doctors, how can we have adequate service?
'No one can see you now': Primary care in crisis amid physician shortage, underfunding
A new report shows that a physician shortage and lack of investment in primary care has caused Americans' average life expectancy to decline.
Below is a story from another link about Florida:
My personal experience with the PCP shortage has made me keenly aware of its consequences for individual patients. My wife (a physician and retired managed care executive) and I were lucky enough to acquire a second home in Florida for the winter months. Being familiar with the idiosyncrasies of healthcare system and adequately insured, we embarked on a search for a primary care doctor who was trained in the U.S., had admitting privileges at a quality hospital, and accepted new patients.Even with both of us doing the research, it took a year to find one – the most junior partner (younger than our children) in a practice that had no online presence and communicated solely by phone. The only alternative was a concierge practice at $5,000 per person annually!
Opinion | Supply Chain Problem for Primary Care
Action is needed to prevent a looming physician shortage
Georgia is spending $50 million to add another medical school because the problems there are acute.
Federal data shows a nationwide primary care shortage. Here’s how Georgia fares.
As Georgia is preparing to fund construction of a new medical school with the hope of solving a shortage of doctors, the federal government has been tracking areas with primary care provider shortages for decades.www.ajc.com
I don't know that physician salaries are too high, I might suspect administrator salaries are.
There is a shortage because there is a fixed supply that's been kept artificially low. Low supply means shortages and higher costs. More rural areas have to pay even higher rates for doctors and specialists to consider moving there.
The AMA and others have finally reversed course and now advocate for increasing the number of physicians, but for a long time they argued for the opposite. And we're all paying for it now.
Check this out....
Since I touted single-payer, I am fine with it just being catastrophic coverage. Anything over some amount. I would suggest $10,000 but we can debate that. It can't be "too" high as most working families can't come close to $30,000. $10,000 frankly would devastate a large percentage. But we can setup something like Singapore. But Singapore is far more autocratic than the US, they pretty much have wage and price controls on their healthcare, I am not sure that would be possible in the US. But parts of it we might be able to steal from, mandatory HSA and catastrophic coverage would be a start.
There is definitely a disconnect occurring based on responses...
@Marvin the Martian we currently have price controls in healthcare. They're just increasing at an increasing rate. They're 100% artificial. And the compounding interest that the public sector receives is only outdone by the compounding interest that the private sector receives.
I asked, "how are goods in healthcare priced?" And @Spartans9312 hit the nail on the head. They're priced based upon a percentage the supplier can extract from the end-user. Therefore, the costs that hospitals are paying for colostomy bags or MRI machines aren't tied to the inputs, but rather tied to the price/value(think FFS) of the service.
If you look at the charts for any good related to healthcare, you will see the same compounding interest curve. Not only that, but the price is based on the assumption that an MRI machine will be used by a ratio of 75% (IIRC)private users and 25% public users. It's the same machine, right? Since, private reimbursements are getting larger at an increasing rate-faster than public reimbursement rates are rising- any hospital that falls below that 75% threshold is "losing money". IOW, the costs for goods and equipment are moving toward the private reimbursement and away from the public reimbursement, because of the divergence between the two compounding interests.
"Just because you woke up on third base, it doesn’t mean you hit a triple." That is too say, people who claim public reimbursement rates are too low, don't understand the dynamics.
Edit to add: There is more than one way to skin a cat. Third parties definitely add to costs. United Health Group...
https://images.app.goo.gl/nFAeyGe6hqSu4nos5
Increasing at an increasing rate...like everything else.
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I don't know if you or Crazed know, but there are a lot of pages out there devoted to the way "not-for-profit" hospitals operate and how it isn't the way we think.
How nonprofit hospitals get away with the biggest rip off in America
The term “nonprofit” hides what’s really going on.
And from the NYTimes link below:
An analysis by Politico found that since the full Affordable Care Act coverage expansion, which brought millions more paying customers into the field, revenue in the top seven nonprofit hospitals (as ranked by U.S. News & World Report) increased by 15 percent, while charity care — the most tangible aspect of community benefit — decreased by 35 percent.
One of the sites suggested that for-profit hospitals get the same reimbursement rates. So, how do they do that AND pay taxes?
