UnitedHealth CEO shot (2 Viewers)

[UncleTrvlingJim]

LOL -never waste a crisis, says the doctors trade association.

Everyone has a story about crazy medical bills but then they’re ready to shoot more people when an insurer tries to follow Medicare’s approach to putting a cap on certain expenses.

Well played by the anesthesiologists, who already average about $350k annually.

“We want lower costs! Medicare 4 All!”
-

“Not like that!!”

It's a good point, b/c single payer does lower costs by essentially dictating the price they'll pay. And presumably if the price they are willing to pay is below what someone is willing to work for, then the outcome is nobody gets that service at all. Which is why price controls often lead to massive shortages and can be miserable failures.

The crux is an issue of trust... there's going to be some "bureaucrat" controlling what gets reimbursed/allowed. Who do you trust to be the one making that call? With insurance companies, particularly in a system where there isn't a lot of real competition (being tied to your place of employment for many of us, and even the exchanges have limited choice) - there is a strong profit incentive to deny costs, and not a lot of fear that consumers will be able to switch to a more generous provider. With a public option, the metric will be something different, though presumably, cost will still be a major driver.

It's been talked about for decades... our current system does not work great. We pay more for worse outcomes than our European counterparts. We pay a LOT more. So clearly there are massive inefficiencies... and we have a dysfunctional system that refuses to correct it.

 

[Mr. Sparkle]

Isn’t this a cart/horse thing
That it’s Medicare , being overseen by people who fetishize the ‘lean mean’ business model who are emulating private healthcare?

Single payer comes with rules, both in what services are covered and the compensation paid to providers. Which is why so many doctors try to avoid Medicare patients.

 

[J-Donk]

It's a good point, b/c single payer does lower costs by essentially dictating the price they'll pay. And presumably if the price they are willing to pay is below what someone is willing to work for, then the outcome is nobody gets that service at all. Which is why price controls often lead to massive shortages and can be miserable failures.

The crux is an issue of trust... there's going to be some "bureaucrat" controlling what gets reimbursed/allowed. Who do you trust to be the one making that call? With insurance companies, particularly in a system where there isn't a lot of real competition (being tied to your place of employment for many of us, and even the exchanges have limited choice) - there is a strong profit incentive to deny costs, and not a lot of fear that consumers will be able to switch to a more generous provider. With a public option, the metric will be something different, though presumably, cost will still be a major driver.

It's been talked about for decades... our current system does not work great. We pay more for worse outcomes than our European counterparts. We pay a LOT more. So clearly there are massive inefficiencies... and we have a dysfunctional system that refuses to correct it.

Realistically, no one is quitting unless they are retiring. There can be no "medical flight" with 1000's of doctors fleeing the states. Every other first world country is single payer as well.

The easiest way to model it would be take the average, adjusted in dollars, in all these other markets and determine a "market rate" for each procedure. It will have some excepetions, but that would work for the vast majority of procedures.

 

[UncleTrvlingJim]

I look at it from the angle of the legal profession - for decades the "billable hour" was the only way anyone billed and clients absorbed all the inefficiency and frankly overbilling that went on. It's still the predominant model but you see a lot more fee for services arrangements now - $10K to get through summary judgement phase, $25K if it goes to trial, etc., as opposed to an open-ended meter running for every 6 minutes that any person inside the firm ever spends thinking about your case.

The anesthesiologists are still on the billable hour. Obviously they don't want anyone messing with it.

Then there's the fact that Obamacare made it (health insurance) into a cartel, removing any real competition - there is no longer any option to provide "cheap" insurance (to cover only catastrophic losses). They all must cover pre-existing conditions. Must carry adult children until they're 26, etc. So now every insurer must cover a larger set of services (with the requisite staff and administration that comes with it) and providers know it all MUST be covered, so there is a lot less pricing power.

Plus, doctors enjoy a wonderful reputation so they are immune to the Eat the Rich sentiment that is prevalent in every other aspect of our population.

An interesting thing I've noticed recently on sort of "Eat the Rich" sites, is more and more people commenting on the salaries of anesthesiologists and radiologists. And relatively benign hours many of them have. However, doctors tend to fit into a model most people understand -- it scales relatively closely to what people think is "fair", a combination of the skill involved, and training time, along with understanding the value they provide - I think people are generally ok with smart people, who spent a lot of time and effort gaining their skills, and providing a service they understand the value of, making a lot of money. Although close a million dollars for 1200 billable hours in some cases, may be pushing it.

The challenge with health care reform is, if you don't mandate coverage for pre-existing conditions, then health insurance loses a lot of value, to the individual and society (ie, any insurance that covers pre-existing conditions will see only sick people on it, jacking the price up; also an insurance company will have an incentive to drop you as soon as you get sick, which of course reduces the value of insurance in the first place). And if you mandate pre-existing conditions but allow healthy people to opt out, then they game the system and only sign up when they need it, and jack the price up for everyone.

 

[UncleTrvlingJim]

Realistically, no one is quitting unless they are retiring. There can be no "medical flight" with 1000's of doctors fleeing the states. Every other first world country is single payer as well.

The easiest way to model it would be take the average, adjusted in dollars, in all these other markets and determine a "market rate" for each procedure. It will have some excepetions, but that would work for the vast majority of procedures.

I think it can be done, but I think knowing the costs/risks of switching models should be fully understood.

 

[guidomerkinsrules]

Single payer comes with rules, both in what services are covered and the compensation paid to providers. Which is why so many doctors try to avoid Medicare patients.

Medicare is not a single payer system though, correct?

 

[Mr. Sparkle]

Medicare is not a single payer system though, correct?

Correct, but its closer to what single payer looks like than purely private health insurance (hence the Medicare for All movement). Medicare is not trying to ape the private healthcare model - in the case of the Anthem/anesthesiologist kerfluffle it's the other way around.

 

[efil4stnias]

It's a good point, b/c single payer does lower costs by essentially dictating the price they'll pay. And presumably if the price they are willing to pay is below what someone is willing to work for, then the outcome is nobody gets that service at all. Which is why price controls often lead to massive shortages and can be miserable failures.

The crux is an issue of trust... there's going to be some "bureaucrat" controlling what gets reimbursed/allowed. Who do you trust to be the one making that call? With insurance companies, particularly in a system where there isn't a lot of real competition (being tied to your place of employment for many of us, and even the exchanges have limited choice) - there is a strong profit incentive to deny costs, and not a lot of fear that consumers will be able to switch to a more generous provider. With a public option, the metric will be something different, though presumably, cost will still be a major driver.

It's been talked about for decades... our current system does not work great. We pay more for worse outcomes than our European counterparts. We pay a LOT more. So clearly there are massive inefficiencies... and we have a dysfunctional system that refuses to correct it.

the medical industry web is so interwoven -from medical school to employment to internal groups and outsourced labs ( and im sure im missing other facets like pharmacy/prosthetics/equipment etc ) - its hard to know where to even start re: price controls.

If we institute controls on the services, will medical schools lower tuition? Thereby reducing the debt physicians enter the workforce with? If not, price control wont work. Is that where we start? Or do we start at the service level and hope med schools follow suit?

And if a med school is forced to lower tuition, do the instructors/teachers/professors take a pay cut and stay on or bolt? Does the level of education drop?

I personally believe it must start at the medical school level. The cost of getting a degree in medicine is outrageous. There is no reason a 28 yr old general practitioner should have $200,000+ in debt to start his/her career in medicine. The lone driving factor for them seeking employment will always be maximum income.

But then i start to think about medical equipment- for instance an MRI machine that can cost anywhere from $1,000,000 to $3,000,000 per machine.

Here is what it cost for CT scanner : ( i had no idea that there were 4 different levels - 16 to 256 slice ( slides ) ) so do you go with the 16 to save money but lose out on resolution?

How Much Does a CT Scanner Cost in 2024?

Learn about the types of CT scanners available and their costs. As well, compare leasing vs. buying this medical imaging equipment.

www.excedr.com

meh i gotta get off this thread. im making my brain hurt and lawd knows i cannot afford a CT scan today. I truly dont know where you start to get a handle on this issue.

 

[UncleTrvlingJim]

the medical industry web is so interwoven -from medical school to employment to internal groups and outsourced labs ( and im sure im missing other facets like pharmacy/prosthetics/equipment etc ) - its hard to know where to even start re: price controls.

If we institute controls on the services, will medical schools lower tuition? Thereby reducing the debt physicians enter the workforce with? If not, price control wont work. Is that where we start? Or do we start at the service level and hope med schools follow suit?

And if a med school is forced to lower tuition, do the instructors/teachers/professors take a pay cut and stay on or bolt? Does the level of education drop?

I personally believe it must start at the medical school level. The cost of getting a degree in medicine is outrageous. There is no reason a 28 yr old general practitioner should have $200,000+ in debt to start his/her career in medicine. The lone driving factor for them seeking employment will always be maximum income.

But then i start to think about medical equipment- for instance an MRI machine that can cost anywhere from $1,000,000 to $3,000,000 per machine.

Here is what it cost for CT scanner : ( i had no idea that there were 4 different levels - 16 to 256 slice ( slides ) ) so do you go with the 16 to save money but lose out on resolution?

How Much Does a CT Scanner Cost in 2024?

Learn about the types of CT scanners available and their costs. As well, compare leasing vs. buying this medical imaging equipment.

www.excedr.com

meh i gotta get off this thread. im making my brain hurt and lawd knows i cannot afford a CT scan today. I truly dont know where you start to get a handle on this issue.

It's a multi-faceted problem. Medical school debt is certainly part of it. Also, your equipment issue is interesting as well... I've often thought about the idea of competition vs excess capacity in the medical field. How many MRI's do you really need in a particular geographic area? Probably fewer than you already have in high population areas, but more in less populated areas... which means there's probably added costs from redundant systems (where you can get it). Not sure if that makes sense - if you have 3 $3million dollar MRI machines in an area where the demand can be fully serviced by 1, then you have a ton of excess capacity which gets passed on as per use cost to each consumer. But how do you solve that? In Norway, it's centrally controlled, which reduces the costs dramatically -- but also leads to a multiple hour drive to get to the equipment for the remote consumer.

How do you address the profit motive tied to a discrepancy in knowledge and an inelastic demand. If I have cancer, I have to get some kind of service to live - so it's not like I can opt out like I can with a cell phone service or avocado toast.... but I don't know as much as the doctor (or the insurer), who both have differing financial incentives (the doctor has an incentive to spend as much as possible both to increase profit, but also to minimize the risk of being sued for not doing enough to save someone), and the insurer to minimize costs (while still providing enough service to prevent customers from fleeing.

I'm good at asking questions... not so good at providing the solutions. But I do believe we need to dramatically the change we do things.

 

[J-Donk]

I think it can be done, but I think knowing the costs/risks of switching models should be fully understood.

The biggest issue that could come up is rural hospitals. If they are no longer able to stay open, does the government take over and run it at a loss? I'm thinking about remote rural areas of the west. Shutting down a hospital might add an hour to someone's travel time for an emergency.

 

[ELLIASJWILLIAMS]

Are thoughts & prayers in-network?

Ouch

Random thought. Medical insurance isn't the problem.

The entire medical system is just outdated. It was designed at a time wehre people were dying from infections, polio, bad sicknesses. In those times, they gave you some medicine..sent you home. They still do to a degree...but people are now dying from chronic diseases.....it wasn't designed for that and they haven't adjusted.

The bigger problem is something we call food.

 

[UncleTrvlingJim]

We haven't even touched on how terrible costs are for mental health. I've talked about this before, but I've probably paid over $150K over the past 5 years for care for my kid... he's doing great now, but it was really just trying a bunch of stuff until we found something that worked, which we could afford, but we ran into tons of kids who came from families who couldn't and they are locked into a pretty terrible cycle now.

 

[SWJJ]

Ouch

Random thought. Medical insurance isn't the problem.

The entire medical system is just outdated. It was designed at a time wehre people were dying from infections, polio, bad sicknesses. In those times, they gave you some medicine..sent you home. They still do to a degree...but people are now dying from chronic diseases.....it wasn't designed for that and they haven't adjusted.

The bigger problem is something we call food.

I agree the poison we call food is a big part of the problem, but I disagree about medical insurance, it ABSOLUELY is a big part of the problem as well.

 

[ELLIASJWILLIAMS]

I agree the poison we call food is a big part of the problem, but I disagree about medical insurance, it ABSOLUELY is a big part of the problem as well.

I should have written that differently. It isn't THE problem, just a branch off a much bigger tree.

 

[CapitalCitySaint]

Ouch

Random thought. Medical insurance isn't the problem.

The entire medical system is just outdated. It was designed at a time wehre people were dying from infections, polio, bad sicknesses. In those times, they gave you some medicine..sent you home. They still do to a degree...but people are now dying from chronic diseases.....it wasn't designed for that and they haven't adjusted.

The bigger problem is something we call food.

Yes. The whole system from the education of our medical professionals to our food supply. However, medical insurance is absolutely the problem. A very big problem.

I have 2 decades working in healthcare on both the acute care/delivery side of things as well as clinical development. This is is broken. Very few things actually work well.