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anongoodnurse
anongoodnurse
18:06
@jkerian - I don't doubt your intentions. But insurance, while it may not be the biggest culprit, is certainly one of the culprits. What is a profit margin? If the executives are making millions dollar salaries, that's considered an expense. Before Obamacare, insurers regularly excluded preexisting conditions, because those conditions would most likely need treatment.
As a pyhsician (I was in private practice before I went into EM), I had my fair share of battles wit insurers on behalf of patients (and to be paid for services, of course); my experience with insurers is than many (not all) were happy to get their premiums but pretty unhappy to pay out.
Medicare isn't the cause of rising prices. One of the major causes is the irrational burdens insurers place of the health care system in order to get paid. Documentation used to be easy. "Pneumonia". Boom. Paid. Now every year, it seems, more and more documentation is required. I remember in private practice hiring someone and sending them to get educated on coding just to meet the insurance coding requirements.
Quoting the NYT: The largest source of waste, according to the study, is administrative costs, totaling $266 billion a year. This includes time and resources devoted to billing and reporting to insurers and public programs. (emphasis mine.)
Another unconscionable cost is the unregulated medical equipment industry. They charge the hospital a ridiculous amount for a colonoscope orf an ex-fix, for example, because they can.
anongoodnurse
anongoodnurse
18:35
Medicare and Medicaid are expensive, but they are not the primary cause of the outrageous cost of medical care in this country. Tis article is fairly balanced: thebalance.com/causes-of-rising-healthcare-costs-4064878
No pun intended. But as someone from the inside, I can attest to seeing a lot of this first hand.
If you care to support your claims, I'd read them. Dollar wise, Medicare and Medicaid cost the US an enormous amount of money for sure, but they are not in and of themselves the reason for the high cost of medical care.
 
3 hours later…
jkerian
jkerian
22:09
To start with a brief aside, CEO salaries are offensive to our sense of fairness, but they're a drop in the bucket when distributed over the sheer number of payers. That's a completely different issue of the lack of corporate governance. Again... it's bad, but it's such a small percentage of the costs that eliminating it wouldn't make anyone happy.
On Medicare/Medicaid, I think you're misunderstanding my point. Medicaid/Medicare caused sticker-price increase (or what passes for sticker prices in the US) because at first they were willing to pay them. This obviously got ridiculous fairly quickly, so then you see the pressure on the agencies to reduce abuse.

That requires checking, verification that such-and-such procedure was appropriate for such-and-such an issue. For the most part this is the "administrative costs" in both the public (medicare/medicaid) and private sector.
(wtf SE... "see full text" is shorter than the version with that appended)
Regarding the cost of devices (and the cost of end-of-life care), one of the major problems the US has is that "standard of care" is extremely nebulous, and prone to getting defined by lawsuits.

"No one gets fired for buying IBM" from the 80s tech world has a corollary of "No one gets sued for using the highest grade equipment/most-extensive-tests/most-treatment we can get/offer".
The problem, as always, is that there are good reasons to keep doctors exposed to lawsuits. There have been pretty horrendous abuses.

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