Comments on Fund My Mutual Fund: Health Care Costs to Rise 10% in 2008 - Uncle Ben ...

Thanks Dr B!Do you know US has 80% of the WORLDs l...

2008-06-19T16:03:00.000-04:00

Thanks Dr B!

Do you know US has 80% of the WORLDs lawyers
Thats our first problem... no offense to any lawyers

But it should be like in the UK - whoever loses the suit pays all lawyer fees. That would stop a portion of the stupid lawsuits like "McDonalds forced me to be fat"

A lot of other problems
as you said, litigation is causing doctors to drop out. We have a major drop out of doctors who do births because I guess its a very highly litigated subsector, so doctors are just throwing their hands up as insurance rates have gone through the roof. So we're losing doctors there

The cost of college is so enormous now for MDs that we are losing primary healthcare providers - everyone (almost) wants to be a speclialist - not so much that they do not want to be a primary health care doctor but the salary difference is so much, and to pay off the enormous college costs the payback is much quicker as a specialist.

Those are but a few things and yes as you say, if doctors don't do EVERY DARN test in the world (even ones that only help 1 in 1000 times) they can be sued - so they have to do 14 tests when in a common sense world they'd do 2 - because in the 1 in 500 case where test 7 would of found something, they would get sued. All that drives up costs.

It's so broken. But we'll keep it tucked in the corner and not shine a light on it... until it turns into the next energy. Thats the amazing thing - our entitlement programs are going to make the energy problems look like a piece of cake :)

All are part of why any "dollar rally" is a short term Wall Street derived dream - our long term road map is literally strewn with disasters waiting. And we'll be printing money to solve all of them.

As a physician I feel the need to chime in with th...

2008-06-19T15:32:00.000-04:00

As a physician I feel the need to chime in with the screwiness of the system based on my view of it:

1. Comparison system
Sounds like a great idea and every physician has a fee schedule that they are mandated to keep. But unlike your car being taken for an oil change - I can't tell you what your visit will wind up costing me in terms of my time (case in point 15 yo female vs. a 65 yo guy - both with chest pain). I am likely to spend 5 minutes with the 1st one and reassure her that she is likely just a tad on the anxious side, and perhaps a half hour with the second one making sure he doesn't drop dead like Tim Russert.

SOLUTION: Have a time based reimbursement system - 15 minutes = $x dollars. BTW, while I can't talk to any other physicians about my fee schedules (called "collusion" and is against the law for me to discuss my fee schedule with another MD), Insurance companies routinely talk to each other and use their info to offer less and less money for more and more work and there is always someone hungrier than you who'll accept these rates. Low rates mean that the doc has to see more patients to generate revenue, which means to you patients that you all feel like cattle being processed instead of human being with an illness.

2. None of the comments mention the cost of defensive medicine. Most docs these days are so afraid of being sued that in the example above they might do the same exact workup for both patients, even though the 1st one has a 0.000001% risk of a heart attack? Why would we waste resources like that? Because if the pt in front of you is that one in a million who has a heart attack at 15, you are on the hook and your career might be over. This is the only country that expects everyone to live forever, for all medicines to have NO side effects, for all doctors to be 100% right 100% of the time, and for the costs to be contained. The cost of defensive medicine far outstrips any other administrative costs due to the system inefficiency.

SOLUTION: Institute caps on lawsuits, have a federal fund for insuring doctors, have the lawsuits vetted by an independent examiner to make sure that the BS ones don't make it through, etc.

3. Our health care system rewards procedures vs. time with patients: i.e. it is far more profitable for hospitals to chop off diabetic feet and take care of their heart attacks than to have a preventative diabetic clinic. The health insurances will pay for the 1st two, but not for diabetic preventative visits (recognize this pattern, Mark?)

I could go on but I have to go see my next patient. BTW, my waiting room is largely empty because I run a mostly cash practice where every pt gets all the time they need, no one gets seen in less than a half hour. Hope this helped illuminate this.

David

P.S. I am bracing for a complete dissolution of the current health care system as the pace of it's growth and status quo is simply non-sustainable in the near or far future.

the problem is all that emergency care use is not ...

2008-06-19T10:31:00.000-04:00

the problem is all that emergency care use is not 'free', it is paid by the rest of us who do have insurance.

So its better to have some "basic service" for everyone for preventative care and then those with means can pay for the extras. But if people were not sitting at home not going to the doctor for 20 years because they cannot afford it, they wouldnt show up at the emergency room with catastrophic illness. In the UK they reward doctors on different measures - i.e. preventative care is job #1. Here its reactive. As is EVERYTHING.

People don't "feel" the cost because they don't see the costs until after. That goes back to showing prices and letting free markets rule. Also electronic records instead of paper would save a lot of money but thats an old horse for a decade - people think electronic records would invade privacy blah blah. But they are happy to use credit cards every day. That all adds cost - its a bloated system... sorry to sound harsh but you put electronic records in and you probably cut 10-20% of the US workforce in healthcare. That would save costs.

Let there be competition. But don't leave the working poor in same conditions as those in 3rd world countries... if you watch that story many hate to ask for a handout, contrare to how Fox News tells us. A lot of people are hard working, and too proud ... others have an entitlement attitude. But its too easy to paint whole classes of people with a broad swath as saying "they want hand outs"

I say to anyone who differs on this viewpoint, cancel your healthcare and live the next 3-5 years afraid of getting sick. Its very easy to talk the talk when one has health insurance which I am sure every pundit who is against any sort of basic care does have.

And entitlement was probably a poor choice of a wo...

2008-06-19T10:09:00.000-04:00

And entitlement was probably a poor choice of a word. People for some reason have the idea that every facet of healthcare should be nearly free. "I have insurance and they will pay." is what I used to always hear. Your idea about hospitals posting prices is a great one if anyone actually cared. When I had my surgery mentioned above each step of the way I asked about the cost prior and people looked at me like I was crazy because "you have insurance."

Posting costs is a great idea! Also, why are cost...

2008-06-19T10:06:00.000-04:00

Posting costs is a great idea! Also, why are costs different from person to person? I recently had ACL surgery and was amazed when I saw the bills. The hospital originally charged $20k, but since I had insurance the bill dropped to $8k. Why wasn't the bill $8k regardless? It seems like to me some funny accounting is going on.

What do you consider a safety net? It is my understanding that anyone who walks in off the street with an emergency is required to receive treatment by law.

I can't find a link to the story, but I saw a story about 3 people and healthcare. 1 person was a typical middle class american with health insurance, a college student, and an illegal immigrant. The person who came out the best after a year of using healthcare? The illegal immigrant. Each time the immigrant needed healthcare, she had no problem getting it and since she was an illegal the hospital didn't even try to make her pay and wrote off the costs immediately. The person that came out the worst was the person who had insurance b/c not only did they have to pay premiums, but also co-pays and deductibles. Something is wrong when the person trying to do the right thing is getting the short end of the stick.

I would also recommend watching a video like this ...

2008-06-19T09:56:00.000-04:00

I would also recommend watching a video like this before saying let everyone just fend for themselves

http://tinyurl.com/2stdp6

Most 1st world countries do have a safety net for the low income and working poor. We do not. That's progress? I don't think the people above are simply living with an entitlement mentality....

Why are health care costs not posted before you go...

2008-06-19T09:47:00.000-04:00

Why are health care costs not posted before you go in so you can comparison shop?

If I break arm, I should be able to go to internet, do a price check on 20 local hospitals, walk in clinics, or the like. And then choose. It drives down price in everything else - but in this its all a secret - and only AFTER you go in do you get the bill.

That alone would save us all a lot of money - no competition. Just like in our schools - no competition. Same results in both.

IMHO, the gov. needs to get out of health care. T...

2008-06-19T09:38:00.000-04:00

IMHO, the gov. needs to get out of health care. They are the ones that have caused the problems to begin with.

People also have to change their entitlement mindset. Insurance is for when something unexpected happens, it is not intended to be for normal checkups and small things like cutting your finger and needing a few stitches. I liken this to having my car insurance pay for my oil changes. This has led to people who are over insured for simple stuff like a visit to the doc and underinsured for a real emergency like a car accident or cancer.

At this point I'm not sure how we fix it though. I think a good start would be to remove the ability for employers to take it out of our checks and just pay us their portion. People need to see the full costs associated with insurance and understand what they are paying for.