Cost of healthcare... in other terms  

rm_VoodooGuru1 50M
2116 posts
4/21/2006 9:46 am

Last Read:
4/26/2006 5:54 pm

Cost of healthcare... in other terms

This is a re-post of a comment I made over at frogger1995's place. Just a little something to take your mind off this beautiful spring weekend.

I'm gonna try not to have an opinion on this 'cause people in my profession aren't supposed to have subjective opinions. These are merely facts, eh?

Healthcare is like any other good... its supply is limited. Americans too often believe they have a right to unlimited healthcare resources (and esp.) of the highest quality. "I don't care if a $250.00 MRI is just as effective for my diagnosis as a $3000.00 PET... I have insurance so fuck you!"

Or, fuck youse as the case happens to be. For the cost of his PET, he and eleven of his closest friends could each have had an MRI.

It's not uncommon for a baby to be born with catastrophic defects that would otherwise be terminal in a few minutes, hours, or days if drastic measures aren't taken. It is not uncommon in these cases for the parents to be fundies or Catholic and believe that the baby's life must be extended as long as possible, regardless of how much pain the child is in, regardless of cost.

It is not uncommon for these NICU babies to live two or more years intebated, hooked up to heart machines, unconscious or never sleeping because of the physical agony.

The financial cost of one of these NICU cases is $1,000,000.00 or more per month!

The opportunity cost of this? $1,000,000.00 will pay the monthly premium of about 2000 families of four. Eight-thousand people!

Another way to think about it is that 8000 people had to go without insurance to keep the coma baby alive. Out of those 8000 people, how many will die because they did not have access to healthcare? How many will die from pneumonia because they didn't have a doctor and just thought it was a bad cold? How many will die from cancer that would have otherwise been caught had they had basic insurance.

Have a great weekend everybody!

rm_saintlianna 46F
15466 posts
4/21/2006 10:13 am

never sleeping because of the physical agony

Please, please tell me thats not true....

rm_VoodooGuru1 replies on 4/23/2006 7:37 am:
OK. It's not true.

caressmewell 54F

4/21/2006 10:47 am

It's not a pretty picture when you count the "beans". It's kinda like fraud and shoplifting...we ALL pay for it, it's hidden in the cost of the goods we purchase.

Kinda like what we pay for the cost of gas to give Mr. Exxon a $400 million dollar retirement....sorry it's off topic but it still chaps my ass...

rm_VoodooGuru1 replies on 4/23/2006 7:40 am:
That's kinda the function of insurance - it aggregates all costs... at least those that are easily quantified.

Knot4Everyone 41F

4/21/2006 6:32 pm

Sad stuff. How do you place a higher value on one life over another? Who sets the cost scale?

I couldn't help but think of the Communist ideals while reading this post - in particular, the "everyone is equal" bit. There's gotta be middle ground between Communism ideals and complete Capitalism. I wonder what that would be like...

Don't get me wrong - I love my country, but we're not perfect. We should always be striving to improve!

rm_VoodooGuru1 replies on 4/23/2006 7:46 am:
I do. I set the "cost scale".

Given the resources and access to data, I could tell you exactly what the opportunity cost is... how many will die from neglected tumors, complications from pneumonia, sepsis.

But no one's ever asked me to analyze this stuff, which is kinda telling, yeah?

frogger1995 40F

4/21/2006 8:45 pm

Like I said...put it on the tax payer dollar and watch the costs landslide. You'd better believe there wouldn't be so many people willing to hold on to the Terri Schiavos of the world...not to mention 10 bucks for a band-aid!

rm_VoodooGuru1 replies on 4/23/2006 7:54 am:
The US$10.00 Band-Aid, much like the $500.00 toilet seat, is a much misunderstood red herring, frogger. Don't use it in rhetoric advocating socialized healthcare, or the finance people won't take you seriously.

mangomamiCT 43F

4/21/2006 11:35 pm

And the malpractice suits ........I'm not talking about gross negligence I'm talkin about .......I deserve 2 million dollars because you "let" my drug addicted brother jump out of a hospital window

rm_VoodooGuru1 replies on 4/23/2006 7:58 am:
I have mixed feelings about malpractice litigation. My problem is when the suit is really about an unfavorable outcome, rather than physician error. Luckily, I don't have anything to do with that stuff.

ediesedgewick 58F

4/22/2006 4:57 am

Many years ago while in school I had the opportunity to interview a mother of a then two-year old premie baby. This baby under normal circumstances would not have lived after birth--but they kept it alive. I wish I could say that at two the baby was finally free of all life-sustaining machines and healthy--but he was not. And seeing what mother and child and physical therapist had to go through each day couldn't help but make me wonder what kind of a life was this for this child--who decided this was the best thing for him?

rm_VoodooGuru1 replies on 4/23/2006 7:58 am:
The family did.

rm_corezon 54F
3376 posts
4/22/2006 12:02 pm

I apologize for hogging your blog here; I wont be insulted if you delete this...this is an opportunity to cite some stuff, make people think a little more about how our current system works.

Your example...true...and that's only one example. How do you place a higher value on one life over another? I think that's a matter of medical ethics and insurance coverage and what you are most likely to be sued over.

Bottom line. Should we do everything that can be done in every situation? No, not really...but there are some really tough calls to make, sometimes. And sick people, people with sick family can be very hard to think rationally at times like this.

That's why JCHAO is now pushing offering DNR's at admissions---doesn't apply to newborns, obviously--they don't get admitted the normal route. There are few pediatricians that could ethically allow a newborn baby to die IF there were treatments matter how serious the deformation...few outcomes are written in can almost ALWAYS do least make the parents aware of what CAN be done...otherwise betcha. What jury is going to side with the doctor that wouldn't treat that poor baby? The malpractice rates for obstetrics is astronomical because of this sort of thing...when all else fails...the doctor and the hospital gets blamed if any way possible. Juries side with parents.

Regarding the costs and inequities of the US Healthcare system:

Not only do we "Americans" have very demanding standards for ourselves when we perceive that we can afford to...

The medical establishment also tends to push the newer and more expensive technologies and tests, too...because they are the "standard" of care and to NOT offer them opens the door for lawsuits...most people don't know any better other than to accept the treatment that is recommended. More lawsuits happen because of what WASN'T done...not what WAS...

We need torte reform; we need to be able to limit malpractice suits and runs up the cost to ALL of us

There must surely be a better way; we may have the best medical care in the world but that is primarily for those that can afford it...and luck up with the best providers...there is no easy way to discriminate. Medicine has traditionally been treated like an art...there are different approaches to virtually everything...but of course the old joke is what to you call the med student that graduates at the bottom of his class? Doctor, of course.

Fewer and fewer here in the US can afford the best health care; with a couple of chronic diseases your monthly meds can keep you from putting food on your table...with one child with a disability...just many of our ER visits and hospital admits are people that would have never been there if they could have afforded to see their family physician regularly, buy their monthly meds and take them like they were supposed to...

Too many people have lost all their credit, their homes, filed for bankruptcy because of catastrophic hospital bills regardless of their insurance coverage which simply WASN'T enough...if you'd ever had to deal with them you know that most reject every possible claim they can usually on the flimsiest of excuses (and yes I'm talking the major insurance providers here)

Healthcare and insurance and suing have become a huge backscratching cogwheel of a big business...and we are all trapped by this triangle as well as our own expectations...I think this is one of the areas where the US system is badly broken and out of control and some sort of universal coverage for basic emergencies and health maintenance and diseases ought to be built into this multitrillion dollar federal budget. There is simply no good excuse for how we are choosing to spend the taxpayer dollar on some of the crap we do (Iraq and private rebuilding contracts anybody?) and failing to take care of our own neighborhoods and our own families.

Consider the other things that increase the indirect cost to all of us though it may not be overtly in the form of taxes:

...the millions of people that use the local emergency room for healthcare because they can be seen without paying up front like they do at the doctor's office because they don't have the money, or the coverage...

...the cutrate Medicaid get on their prescriptions and the price our companies are selling their meds to other countries for; the difference in cost is passed indirectly onto those without Medicaid or prescrition coverage because they will be charged to make up for the shortfall...

...the huge malpractice awards drive up the cost of malpractice for both the hospitals and physicians which in turn drives up the cost of doing business

...the salaries of all the people that are employed by Medicare and the insurance companies and your local providers licensed by your friendly federal government that are constantly dreaming up new diagnosis codes at the last minute so they can reject claims that have to be sent and then recent through the system...helps to drive up the cost of your is by NO means just the claims they pay out running up the cost

...and yes (not saying we dont need the FDA here) but many of the FDA and Federal Registry regs (another name for bureaucratic laws) our companies and hospitals have to obey here are so incredibly complicated...My opinion is that they don't do much to ensure the quality of much of anything other than the appearance of complying paperwork...(remember, appearance is all in this day and age)...we use alot of manpower, pay alot of people some HUMONGOUS money to not only understand and keep up with these regs but to implement them...we have special interests involved in this bureaucratic morass too...other countries don't have this same cost built into the cost of doing business...

The current system is a huge white elephant that takes a tremendous amount of money just to keep it afloat as it is...continually driving up the cost for ALL of us.

A tremendous amount of resources are being put into the system ANYWAY and that I think that these resources could be utilized more effectively a DIFFERENT way...and that does open the door for some sort of socialised system.

rm_VoodooGuru1 replies on 4/23/2006 8:05 am:
Ah, corezon... you're in the biz too, eh?

Thank you for your post. I agree with most of what you assert, and can't add much.

I wonder though, if you've ever seen med or (esp.) pharma utilization by employer or industry group? Say, the utilization patterns of teachers, or union members, for example? Some of it is truly shocking.

rm_1hotwahine 64F
21091 posts
4/22/2006 10:46 pm

I've tried to comment on this a few times now. But this situation that we're in - where no side is willing to take any step whatsover away from their position regarding health care or anything else, makes it difficult to work up a good head of steam about it.

Hawaii has several programs in place that work better in headlines than they do in real life. However, the Participating Physicians cost cap, which encourages those with medical insurance to utilize physicians and facilities who are "Participating Members" and thereby agree to a cap on charges, actually seems to work. I'm not looking at this from a political perspective but as a former Human Resources Director (read: benefits administrator)in the private sector and as an insured individual. I'm not saying it's the greatest thing since sliced bread and it doesn't even begin to scratch the surface of what you're saying. But it HAS the spark of something that works. And is also a preferred alternative to the hated HMO.

On the other hand...
If you ever read about Hawaii's Prepaid Health Care Act and how, along some voodoo Gap Plans, it insures that Hawaii's residents all have qualified health care - don't believe it. It's bullshit. And nothing personal was intended with the voodoo terminology, lol. But it HAS caused to finally understand the handle. (hmmm...that's great)

Touching on the post a little more conceptually-
Personally I am amazed at the extremes that some feel compelled to prolong a human life for a few years. I mean really, it's not like it isn't gonna happen anyway. And I don't mean that negatively at all; just very matter-of-factly.

OK, returning to my beautiful spring weekend now...

Yeah, I'm still [blog 1hotwahine]

rm_VoodooGuru1 replies on 4/23/2006 8:10 am:
This "Participating Physicians cost cap" sounds exactly like an HMO model, only members are allowed to go outside the PP network. I'd expect it would be more costly than a strict HMO.

What's the diff?

MissAnnThrope 57F
11488 posts
4/22/2006 11:39 pm

You know, what you say is true. In the very rare cases where a baby is born with just a brain stem, they still keep it alive for the maximum two weeks it can live on life support. Look at the Terri Schaivo debaucle last year. 100 years ago, she would have died. A feeding tube would not have been an option. Frist did the same thing to his father a few years earlier, but used Mrs. Schaivo to try to promote himself politically.

I don't believe in keeping any terminal patient who is in agony alive, be it an 80 year old or an 8 hour old. Just let them go.

rm_VoodooGuru1 replies on 4/23/2006 8:13 am:
Heh! You and I have seen every obscure and evil website, haven't we?

I really didn't care for the pics, but the war between the two factions was hilarious.

rm_1hotwahine 64F
21091 posts
4/23/2006 2:13 pm

The diff is that the vast majority of physicians in private practice are Preferred Providers. So they have the freedom to develop their practice where and how they choose, and I have the freedom to choose any healthcare provider that I want. The pot is sweetened by the insurance company for the medical provider in several areas - ease of billing (I only pay PPs my % owed and they can bill the insurance company directly for majority of it, which is paid routinely and quickly) is the main one, plus the advantages to the insuree makes us tend to choose the PPs.

And for me, there is no annual deductible for using PPs and the pay just my % thing is great for me as well. Non PPs - I have to pay up front and be reimbursed.

It sort of strong arms the physicians into keeping their prices low AND (here's the relevant part) not getting carried away with unnecessary procedures. That in itself can keep the costs down (although 'down' is pretty subjective, ha).

The fact that we practically have a monopoly re: one insurance provider probably accounts for 70% of medical insurance in Hawaii makes this whole thing work. So yeah, the origins are questionable, but stilll...

We are an interesting study for many things, as we are self-contained in a way no other US state is. But don't take my word for is; come check it out for yourself.

Yeah, I'm still [blog 1hotwahine]

rm_rsp54 59F
531 posts
4/24/2006 10:03 am

I agree with completely, especially on the issue of newborns. Friends of mine had twins at19 weeks. In years gone by, they would have died. My friends insurance plan exceeded the lifetime maximum before the first month had elapsed. They were basically told to quit their jobs and go on welfare, because there were no lifetime maximums in that case. The twins are now four months old, still on life support with little chance of ever living a happy productive life.

As for the MRI/PET issue...most people do not know enough about these modalities to know what each is good for diagnostically. If I had melanoma, I would not take kindly to being told that an MRI would suffice...price of MRI closer to a grand, though. PET's are about what you stated. I was a PET tech in a former lifetime.

By the same token, my husband is self employed...he makes very good money, but our insurance sucks. Our college aged kids are not covered, we have no perscription coverage, or doctor's visits, because we are not part of a group. As a result, I visit the doctor's(as should be) sparingly. I take one perscription drug to counteract the affects of having a tumor removed from my nasopharnyx, several years ago. Now the insurance company says that it is not in their formulary and will not count towards my thousand dollar deductable on Major Medical. Ill stop my rant now, because I could tell you volumes!!!!

Fox4aKnight1 44F

4/25/2006 1:55 am

I will only say I am on medicare ........nuff said ....

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