Cigar Aficionado Online    Cigar Aficionado Forums  Hop To Forum Categories  Cigar Talk    Why Medical Bills Are Killing Us
Page 1 2 3 
Go
New
Find
Notify
Tools
Reply
  
Why Medical Bills Are Killing Us
 Login/Join
 
Member
Picture of SubChop
posted
Here's a very interesting article that discusses the cost of health care in the US.

Time Magazine

One reason I found it interesting is because it focuses mainly on why prices are so high, rather than on who should pay them.

I had never heard the term 'chargemaster' before, but it is the basis for the amounts charged to people not on Medicare or without adequate insurance. An example given was charging an uninsured person $18 each for a diabetes test strip, which can be bought online for as little as $0.55.

Apparently this Chargemaster is important even to those with insurance, because it is often the basis used to negotiate an insurance companies particular rates.

Have any of you heard the term Chargemaster before or something similar with the same purpose?

Another shocking example was a particular test used on a woman, that cost her $8K. The same test on a Medicare patient would have cost the system $554!

Another surprise to me was that 'non-profit' hospitals actually can produce profits. How does that work?

It's a long and fascinating article, which I'm still in the process of reading.
 
Posts: 2795 | Location: New England | Registered: August 03, 2007Reply With QuoteReport This Post
Member
Picture of boolee
posted Hide Post
Only in America....


Give life a try...
 
Posts: 773 | Location: Hollywood, SC | Registered: September 09, 2012Reply With QuoteReport This Post
Member
Picture of ninjasaurus
posted Hide Post
Full disclosure-I'm a periodontist. I didn't, and won't, read the Time article because the argument over healthcare costs is redundant and silly. The reason Medicaid/Medicare costs are different than private/self-pay costs is because the latter subsidizes the former in most settings. A strip may be $.55 online-little overhead, and $18 at a healthcare center (hospital or whatever)-very high overhead and the need to socialize the expenses because there are a lot of people who can't/don't end up paying anything. The $8k test may cost $4k to run with lab/machine/technology costs and personnel costs. But at $500 per "x" amount of runs it would bankrupt the clinic. So they charge $8k for "y" runs to balance the loss. This is not related to physician/dentist salary, which is a common argument. Regarding salary, it's deserved 100%, and that's a separate topic.

Non-profit centers still legally can make a profit, and that isn't contradictory to what they are set up to do. Non-profits just have different tax liability and need to strictly adhere to specific structuring and tax codes. They still require a profit to build cash reserves and balance varying changes in expenses and revenues. If they didn't make a profit they wouldn't exist.


I hate f-ing pickles.
 
Posts: 165 | Registered: September 09, 2012Reply With QuoteReport This Post
Member
Picture of SubChop
posted Hide Post
quote:
Originally posted by ninjasaurus:
Full disclosure-I'm a periodontist. I didn't, and won't, read the Time article because the argument over healthcare costs is redundant and silly. The reason Medicaid/Medicare costs are different than private/self-pay costs is because the latter subsidizes the former in most settings. A strip may be $.55 online-little overhead, and $18 at a healthcare center (hospital or whatever)-very high overhead and the need to socialize the expenses because there are a lot of people who can't/don't end up paying anything. The $8k test may cost $4k to run with lab/machine/technology costs and personnel costs. But at $500 per "x" amount of runs it would bankrupt the clinic. So they charge $8k for "y" runs to balance the loss. This is not related to physician/dentist salary, which is a common argument. Regarding salary, it's deserved 100%, and that's a separate topic.

Non-profit centers still legally can make a profit, and that isn't contradictory to what they are set up to do. Non-profits just have different tax liability and need to strictly adhere to specific structuring and tax codes. They still require a profit to build cash reserves and balance varying changes in expenses and revenues. If they didn't make a profit they wouldn't exist.


Redundant? Not for me!
Silly? - Hardly!

And since you won't read the article, your post means nothing!

I read further and learned that "non-profit" simply means they can't distribute earnings to shareholders (because they don't have shareholders). Their profit comes after expenses, so your comment regarding the need for profit to "exist" is inaccurate.
 
Posts: 2795 | Location: New England | Registered: August 03, 2007Reply With QuoteReport This Post
Member
posted Hide Post
quote:
Another surprise to me was that 'non-profit' hospitals actually can produce profits. How does that work?


the 'not for profit' hosp group I worked for paid the president $1.8M dollars and keeps building or buying new hospitals. they gotta keep spending the $$$. you don't ever want to know how much $$$ is pissed away at a not for profit hospital just because they have so much to get rid of.
 
Posts: 415 | Location: Central Ohio | Registered: February 04, 2008Reply With QuoteReport This Post
Member
Picture of Vision
posted Hide Post
Health insurance in America is expensive for many reasons, but a major reason prices are so high is too many people...including illegal aliens...use emergency rooms as their doctor/for personal convenience.

Obamacare has compounded the problem. From a high level standpoint...not focusing on the move to make the government the provider of health care...it demands insurance companies pay out more benefits with only a weak promise to put more money into the system.

2014, the year of Obamacare will bring significant rate increases because of it. We are on an unsustainable path and the suffering Obama has inflicted on business...particularly small business is reprehensible.

These are simply facts.


___________________________________________________________

"Living well, is the best revenge."
 
Posts: 7060 | Location: Baltimore, MD | Registered: August 08, 2008Reply With QuoteReport This Post
Member
Picture of ninjasaurus
posted Hide Post
Subchop

I'm glad you understand profit exists after expenses. That's what profit is; the money you make after expenses. No, my opinion may not matter much, I'm okay with that. You should understand neither does yours. It's a message board for opinions. They mean only what someone else makes of them. I don't need to read the article to understand how healthcare works or to know why a non profit is allowed to makes money above their cost of doing business.

Healthcare insurance as it is now is a mess and out of control. We are headed toward full socialized medicine. Many people love the concept of "free" healthcare. But they want it free and to remain at the same level of quality they have now. This is impossible--ask Europe. I billed $788 for a bone grafting procedure when an implant was not stable at placement. The insurance wants to pay me $122. That doesn't even cover the cost of the materials much less my total overhead. Guess what? If I can't charge $788 and have the patient pay in full-no one gets that procedure done because my wife and kid don't eat on negative cash flow. Now, I could charge $1500 per procedure to subsidize the $122 payouts. But that increases the cost of care off everyone. Now if the insurance would just pay a fair amount, I could probably drop my fee a bit and everyone could be treated as they needed to be.


I hate f-ing pickles.
 
Posts: 165 | Registered: September 09, 2012Reply With QuoteReport This Post
Member
Picture of SubChop
posted Hide Post
quote:
Originally posted by ninjasaurus:
You should understand neither does yours. It's a message board for opinions.


Maybe, but since I created the thread to discuss the article, I would hope only those that also had read the article would post their opinion - otherwise it is basically thread jacking.

quote:

Healthcare insurance as it is now is a mess and out of control. We are headed toward full socialized medicine. Many people love the concept of "free" healthcare. But they want it free and to remain at the same level of quality they have now. This is impossible--ask Europe. I billed $788 for a bone grafting procedure when an implant was not stable at placement. The insurance wants to pay me $122. That doesn't even cover the cost of the materials much less my total overhead.


Total overhead? You're trying to cover your total overhead on ONE procedure? Given the examples in the article, what was the line item breakdown in that $788 bill?

quote:

Guess what? If I can't charge $788 and have the patient pay in full-no one gets that procedure done because my wife and kid don't eat on negative cash flow. Now, I could charge $1500 per procedure to subsidize the $122 payouts. But that increases the cost of care off everyone. Now if the insurance would just pay a fair amount, I could probably drop my fee a bit and everyone could be treated as they needed to be.


Did you know the status of the patient's coverage before performing the procedure? If so, you knew what would be covered.
 
Posts: 2795 | Location: New England | Registered: August 03, 2007Reply With QuoteReport This Post
Member
Picture of sobek
posted Hide Post
quote:
Originally posted by SubChop:
Total overhead? You're trying to cover your total overhead on ONE procedure? Given the examples in the article, what was the line item breakdown in that $788 bill?


He is saying the insurance company is negotiating for less than the cost of materials for that procedure.



quote:

Did you know the status of the patient's coverage before performing the procedure? If so, you knew what would be covered.


A patient being covered is not the issue. Insurance companies rarely pay the full bill. Different companies will negotiate/offer different amounts, depending on the procedure.
 
Posts: 7781 | Registered: June 29, 2003Reply With QuoteReport This Post
Member
Picture of ninjasaurus
posted Hide Post
Thanks Sobek. Subchop you're taking all this the wrong way. You started the thread and that's that. Your opinion was one and mine another. This isn't personal and never meant to be an attck on you.

No, I don't cover total overhead on one procedure. I have overhead for each hour of business in the form of operating expenses: rent, wages, utilities...then there is the cost of the procedure itself, which includes the materials plus what i have to make (I dont work for negative money or for free. I have to profit and pay student loans). I won't quote you a line item breakdown on the procedure because you don't need to know that and it's irrelevant. That was an example related to you citing diabetes strips and lab tests; things cost money and the fact that cost online is different than cost in a clinic. Additionally, clinics may have to subsidize cost (read socialize medicine). With regard to knowing my patient's coverage, I'm not in network for any insurance provider (ie, fee for service). This particular case illustrates the insurance company's mentality and why healthcare cost is what it is in certain settings. This particular case was bit convoluted with billing and I'll leave it at. My point is, from the insurance companies perspective, I deserved $122, which didn't remotely cover the cost of the procedure, that is not including profit. Don't worry, I'm getting paid $788 combined from the patient and the insurance company.


I hate f-ing pickles.
 
Posts: 165 | Registered: September 09, 2012Reply With QuoteReport This Post
Member
Picture of ninjasaurus
posted Hide Post
Oh, regarding "who should pay costs"...generally, you should. Insurance should not be for routine care. That should be out of pocket. Insurance should be reserved for unexpected costs. You don't have auto insurance to cover oil changes and alignments. If your mechanic tells you you need $1000 in car maintenance, you pay it. You don't bill your insurance. You have auto insurance to pay for large costs associated with accidents and total loss occurrences. However, if people have routine check ups and minor medical/dental bills that equal $1000 they freak out if they pay out of pocket. We have been conditioned to rely on insurance for all of our healthcare costs less copays and relatively speaking small deductibles, which is wrong.


I hate f-ing pickles.
 
Posts: 165 | Registered: September 09, 2012Reply With QuoteReport This Post
Member
Picture of KF
posted Hide Post
quote:
Originally posted by ninjasaurus:
Oh, regarding "who should pay costs"...generally, you should. Insurance should not be for routine care. That should be out of pocket. Insurance should be reserved for unexpected costs. You don't have auto insurance to cover oil changes and alignments. If your mechanic tells you you need $1000 in car maintenance, you pay it. You don't bill your insurance. You have auto insurance to pay for large costs associated with accidents and total loss occurrences. However, if people have routine check ups and minor medical/dental bills that equal $1000 they freak out if they pay out of pocket. We have been conditioned to rely on insurance for all of our healthcare costs less copays and relatively speaking small deductibles, which is wrong.


I've got a 1500 dollar deductible. I pay out of pocket until it is met then insurance covers 80%. If using insurance only for unexpected costs... When I had heart surgery, it wasn't "unexpected". Yet, it was about a 50k dollar procedure. Should I have to pay this out of pocket? I'd have to sell a kidney or make payment/drain my savings in order to fund it. Insurance was a blessing in this case.

Other then instances like this, I can see your point.


Every man dies. Not every man really lives. - William Wallace
 
Posts: 936 | Location: Ky, USA | Registered: January 01, 2013Reply With QuoteReport This Post
Member
Picture of ninjasaurus
posted Hide Post
No, maybe unexpected was mis-stated. I was referring to auto insurance for that. Medical costs of that nature are what insurance is for.


I hate f-ing pickles.
 
Posts: 165 | Registered: September 09, 2012Reply With QuoteReport This Post
Member
Picture of KF
posted Hide Post
quote:
Originally posted by ninjasaurus:
No, maybe unexpected was mis-stated. I was referring to auto insurance for that. Medical costs of that nature are what insurance is for.


Gotcha man. As far as auto insurance... Talk about a scam.


Every man dies. Not every man really lives. - William Wallace
 
Posts: 936 | Location: Ky, USA | Registered: January 01, 2013Reply With QuoteReport This Post
Member
Picture of Krazeehorse
posted Hide Post
Insurance is part of the problem. It makes additional work for the provider to collect their fee. Hence the fees have a lot of clerical costs built in. I spent about three hours in our local emergency room last summer. I am self employed so I don't have great insurance. The nurses treated me great and spent a lot of time with me. The doctor walked in a couple times and asked how I was feeling. Literally less than two minutes of face time over the visit. He does not work for the hospital, rather he works for a doctors group that contracts their services. But they do not accept my insurance. So after paying the hospital what my insurance didn't cover I get another bill for almost $400 from the doctors group. I simply refuse to pay cash for such an exorbitant rate. When you have great insurance that pays for everything you tend to not care what was charged....but you should.


The difference between genius and stupidity is genius has its limits. Albert Einstein
 
Posts: 1765 | Location: NW Ohio | Registered: August 25, 2009Reply With QuoteReport This Post
  Powered by Social Strata Page 1 2 3  
 

Cigar Aficionado Online    Cigar Aficionado Forums  Hop To Forum Categories  Cigar Talk    Why Medical Bills Are Killing Us

© Cigar Aficionado Online 2014