Excerpted from The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care
Will it make a difference?
Jim Epstein | March 13, 2013
http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac (http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac)
Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk.
"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.
Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.
Obamacare, which takes full effect in 2014, will drive up costs and erode qualityâ€"and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)
Whole article here: http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac (http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac)
Can't argue with that.
Wow if only we had given the Healthcare industry a chance to be efficient and competitive for years before Obamacare stepped in. Oh wait we did they dropped the ball to the tune of averaging 20% increased premiums per year and refusing to cover anyone who wasn't young and healthy then dropping them if they ever had the gall to be sick. Now we all know that a private system could work but the history of Humans is that private healthcare refuses to work.
In 1947, I believe, healthcare was tied to employment by the federal tax code and selling health insurance across state lines became illegal. We currently have a relatively free market for elective surgery. Customers pay directly out of their own pocket. Pricing info is readily available and surgeons compete against each other on price and quality. Studies show quality increasing and prices decreasing.
insurance and the healthcare industry could have fixed this problem years ago, but greed has driven the entire industry for what seems like forever. I don't blame doctors who spend a great deal of money for their education for wanting to be compensated for their work and years of their life to become a doctor, but the cost of healthcare is out of control. Both sides are guilty of ridiculous charges and over billing. Healthcare Reform is not the best it could have been but it's a start. The entire healthcare industry had it's chance but they blew it so stop groaning about "OBamacare."
Quote from: stephendare on March 14, 2013, 09:57:07 AM
Quote from: urbanlibertarian on March 14, 2013, 09:39:42 AM
In 1947, I believe, healthcare was tied to employment by the federal tax code and selling health insurance across state lines became illegal. We currently have a relatively free market for elective surgery. Customers pay directly out of their own pocket. Pricing info is readily available and surgeons compete against each other on price and quality. Studies show quality increasing and prices decreasing.
Actually UL, Thats really only true about cosmetic surgery in general, and a few procedures like gastric bypass and what are now called 'procedures' ----not really a common term in the 40s--- that have been vastly cheapened by technology.
If you read the whole article these doctors who don't accept insurance can charge substantially lower fees for a whole range of services because of the paperwork that is eliminated and because of the horse trading between insurance companies and big providers. Cosmetic and laser eye surgery is not covered by insurance and providers compete on price and quality by, among other things, improving technology. Severing the link between private health insurance and employment and allowing interstate sales would increase competition in the health insurance market. Insurance companies, unions and most big businesses don't want this but it would help lower costs.
Quote from: avonjax on March 14, 2013, 09:59:11 AM
insurance and the healthcare industry could have fixed this problem years ago, but greed has driven the entire industry for what seems like forever. I don't blame doctors who spend a great deal of money for their education for wanting to be compensated for their work and years of their life to become a doctor, but the cost of healthcare is out of control. Both sides are guilty of ridiculous charges and over billing. Healthcare Reform is not the best it could have been but it's a start. The entire healthcare industry had it's chance but they blew it so stop groaning about "OBamacare."
Competition overcomes greed in a free market.
Quote from: stephendare on March 14, 2013, 10:27:09 AM
Quote from: urbanlibertarian on March 14, 2013, 10:22:13 AM
Quote from: stephendare on March 14, 2013, 09:57:07 AM
Quote from: urbanlibertarian on March 14, 2013, 09:39:42 AM
In 1947, I believe, healthcare was tied to employment by the federal tax code and selling health insurance across state lines became illegal. We currently have a relatively free market for elective surgery. Customers pay directly out of their own pocket. Pricing info is readily available and surgeons compete against each other on price and quality. Studies show quality increasing and prices decreasing.
Actually UL, Thats really only true about cosmetic surgery in general, and a few procedures like gastric bypass and what are now called 'procedures' ----not really a common term in the 40s--- that have been vastly cheapened by technology.
If you read the whole article these doctors who don't accept insurance can charge substantially lower fees for a whole range of services because of the paperwork that is eliminated and because of the horse trading between insurance companies and big providers. Cosmetic and laser eye surgery is not covered by insurance and providers compete on price and quality by, among other things, improving technology. Severing the link between private health insurance and employment and allowing interstate sales would increase competition in the health insurance market. Insurance companies, unions and most big businesses don't want this but it would help lower costs.
urban libertarian. This does sound nice in theory.
Any examples of it being true anywhere around the world?
http://www.bizjournals.com/seattle/news/2013/01/03/cambia-health-solutions-invests-in.html?page=all
http://www.yelp.com/biz/qliance-medical-group-seattle
There are others. Just search for "direct care". Usually on the west coast.
I do not believe this is a big fix for the U.S. but hey more power to them if they can lower costs.
^I don't know of any that have completely kicked the insurance racket out of the communities (that aren't government socialized, like Cuba). At this point, its probably way too intrenched in the medical world to do that here now. Although I'm sure small towns/communities do exist (like in very rural or poor parts of the country) where a primary doctor doesn't work with insurance at all & just lets people pay directly (think a "Doc Hollywood" type setting), I don't know of any specifically though. Its prob not one of those things that gets noticed or a lot of press.
But I do know that back in the day it was a lot more common. The town I grew up in, everyone paid directly & there was only a couple docs in the whole town/county. And if you go back even further (like in my parent's day), then even more so. This was rural Kentucky. But its prob not like that now though. Even a basic visit out of pocket would be quite a bit of money now.
I'm with you though, Stephen. I despise the system. I either want to go back to direct pay between patient & doctor, or a complete revamped socialized system. All these slime ball middlemen are fucking killing us. And from what I understand, while Obamacare does do some good, its mostly forcing everyone into the racket. And if you don't want to play, then you're going to pay.
Let's hope it can/will be modified for the benefit of the people (and not the insurance companies). I tend not to put too much hope into these things until I see the final results. But really this all boils down to profit before people. Its the same with everything these days, even philanthropists like Bill Gates knows it. http://www.wired.co.uk/news/archive/2013-03/14/bill-gates-capitalism#.UUGe-5TS1fE.reddit He's done a lot of good, but he also knows that it can only go so far as long as things are the way they are (the whole profit over people thing).
I'm not blaming capitalism in its pure form & when its giving everyone opportunities & not leeching off people, but thats not what we have. And I also think the days of everyone getting a job, going to college, etc & still being able to live some meaningful life are indeed coming to an end. We've let the big baks, corporations, etc milk this thing dry. What a sad state we're all in when they have the power to make or break all of us in so many different ways. So we're going to have to rethink the way society as a whole works, or keep the current system & dive headfirst into the abyss IMO.
But again, anytime you bad mouth the system that we have people think you're a damn dirty communist, so there you go.
I do not believe it (obamacare) is better than what was happening before. It is more of the same, with deck chairs moved around, guaranteed profits for insurers (who aren't hurting currently), more bureaucracy (private and public), forced participation, and higher premiums.
I'm sure Republicans are to blame in this, so I'm fine with saying it's their fault.
I am initially an absolutist in principle, then upon reflection I generally move to middle ground and pragmatism.
I've had plenty of time to reflect on Obamacare. It is simply more of a bad thing: Private insurers extracting value form the Health Care sector, with providers being complicit.
There are two solutions: Single Payer, or pay as you go on an individual basis. Both tend towards absolutism, but our current system is so muddled, I see no reforming it.
The first thing that should have been done to help solve Medicaid and access for the poor to quality internal/family medicine physicians........was to have the states pick up their malpractice insurance costs in exchange for treating/accepting, for no charge, a certain number of Medicaid patients a year. The states could get a much better rate. It's a win win.
Instead you have a situation where physicians have no incentive for taking on an enormous headache.
Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.
Quote from: ChriswUfGator on March 19, 2013, 07:58:35 AM
Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.
Are those costs the actual payments made for malpractice claims or is that the cost of malpractice insurance that doctors carry to protect themselves? How about providing some context for your stats.
Quote from: stephendare on March 19, 2013, 10:18:39 AM
Quote from: carpnter on March 19, 2013, 09:49:16 AM
Quote from: ChriswUfGator on March 19, 2013, 07:58:35 AM
Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.
Are those costs the actual payments made for malpractice claims or is that the cost of malpractice insurance that doctors carry to protect themselves? How about providing some context for your stats.
Um, yeah. Two percent. And thats being generous.
Interesting that you think that the problem with malpractice isnt the lives ruined or the deaths, but the cost of the insurance to the people committing the malpractice.
Maybe you ought to ask yourself why tylenol costs 12 dollars for a pill in the hospital.
I simply want to know what costs the 2% encompasses. You shouldn't make assumptions on what I think when I made no statement about malpractice itself.
Tylenol costs $12 because there is more to the cost than just the cost to the pill, there are all of the administrative costs involved in dispensing that medication. From the person getting the medication from storage, to the person dispensing it to the patient, to the systems or people used for tracking the inventory of the medications. Whether that cost is fair or realistic for the hospital to charge is something that should be discussed, but without all of the information it is impossible to make any determination if that cost which on its face appears to be ridiculous, is actually justified.
I don't know the TIME article Bitter Pill has yet been referenced. It's stunning how effective the healthcare industry has been at shifting the debate from "why does everything cost so much (http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/why-an-mri-costs-1080-in-america-and-280-in-france/)" to "who is going to pay for it". When Medicare reimbursement rates for something like CT scans are 3-4 times more expensive than other countries, it's no wonder than healthcare is bankrupting us.
Talk to doctors. By and large they have no idea how much the services they're providing cost, or even who's responsible for setting the prices. They talk about malpractice reform and defend their own pay because those are the only dollar signs that affect them. I'm not saying that malpractice reform isn't necessary or that doctors are paid too much, just that first-line providers are entirely disconnected from price and instead rely on very specific guidance like this (http://www.ahrq.gov/clinic/uspstfix.htm) for what labs and tests they order.
carptner what are room charges/facility fees for then? Why are washable hospital gowns that cost $30 to purchase billed at $80 time after time? Shouldn't that $1,500 room charge cover the labor and materials needed or does hospital laundry really cost $50 bucks an ounce? Why is the fact that chargemaster costs are entirely arbitrary, and thus entirely negotiable, a deep dark secret?
Quote from: stephendare on March 19, 2013, 11:41:11 AM
Quote from: carpnter on March 19, 2013, 11:34:30 AM
Quote from: stephendare on March 19, 2013, 10:18:39 AM
Quote from: carpnter on March 19, 2013, 09:49:16 AM
Quote from: ChriswUfGator on March 19, 2013, 07:58:35 AM
Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.
Are those costs the actual payments made for malpractice claims or is that the cost of malpractice insurance that doctors carry to protect themselves? How about providing some context for your stats.
Um, yeah. Two percent. And thats being generous.
Interesting that you think that the problem with malpractice isnt the lives ruined or the deaths, but the cost of the insurance to the people committing the malpractice.
Maybe you ought to ask yourself why tylenol costs 12 dollars for a pill in the hospital.
I simply want to know what costs the 2% encompasses. You shouldn't make assumptions on what I think when I made no statement about malpractice itself.
Tylenol costs $12 because there is more to the cost than just the cost to the pill, there are all of the administrative costs involved in dispensing that medication. From the person getting the medication from storage, to the person dispensing it to the patient, to the systems or people used for tracking the inventory of the medications. Whether that cost is fair or realistic for the hospital to charge is something that should be discussed, but without all of the information it is impossible to make any determination if that cost which on its face appears to be ridiculous, is actually justified.
hmm. CVS found a way to store all of that tylenol and still manage to get the costs under 12 dollars per pill. Are you under the impression that hospitals hire the swiss national guard to watch these tylenol pills while they are beings stored? In an underground vault constructed purely of titanium, tungsten steel and gold?
Nice straw man comparing a CVS to a hospital. Do you know what regulations apply to hospitals when it comes to storing medication? I certainly do not know all of the requirements AHCA has regarding it.
Quote from: stephendare on March 19, 2013, 12:03:35 PM
Quote from: carpnter on March 19, 2013, 12:02:56 PM
Quote from: stephendare on March 19, 2013, 11:41:11 AM
Quote from: carpnter on March 19, 2013, 11:34:30 AM
Quote from: stephendare on March 19, 2013, 10:18:39 AM
Quote from: carpnter on March 19, 2013, 09:49:16 AM
Quote from: ChriswUfGator on March 19, 2013, 07:58:35 AM
Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.
Are those costs the actual payments made for malpractice claims or is that the cost of malpractice insurance that doctors carry to protect themselves? How about providing some context for your stats.
Um, yeah. Two percent. And thats being generous.
Interesting that you think that the problem with malpractice isnt the lives ruined or the deaths, but the cost of the insurance to the people committing the malpractice.
Maybe you ought to ask yourself why tylenol costs 12 dollars for a pill in the hospital.
I simply want to know what costs the 2% encompasses. You shouldn't make assumptions on what I think when I made no statement about malpractice itself.
Tylenol costs $12 because there is more to the cost than just the cost to the pill, there are all of the administrative costs involved in dispensing that medication. From the person getting the medication from storage, to the person dispensing it to the patient, to the systems or people used for tracking the inventory of the medications. Whether that cost is fair or realistic for the hospital to charge is something that should be discussed, but without all of the information it is impossible to make any determination if that cost which on its face appears to be ridiculous, is actually justified.
hmm. CVS found a way to store all of that tylenol and still manage to get the costs under 12 dollars per pill. Are you under the impression that hospitals hire the swiss national guard to watch these tylenol pills while they are beings stored? In an underground vault constructed purely of titanium, tungsten steel and gold?
Nice straw man comparing a CVS to a hospital. Do you know what regulations apply to hospitals when it comes to storing medication? I certainly do not know all of the requirements AHCA has regarding it.
this certainly hasnt kept you from invoking them after every paragraph, has it?
But I do notice that in the multiple reasons why you mentioned that would explain the unreasonable and crazy cost of tylenol, you didnt list 'insurance and litigation', which I think answers your original question.
Stephen, my answer was not meant to be all encompassing. I was listing some of the reasons, the costs could be so high. The problem is we do not see those other costs so we cannot make a judgement on whether the cost for the Tylenol (or any other medication) is justified. It may or may not be.
Neither insurance companies or the government (Medicare/Medicaid) pays anywhere near the bill rate for medical care.
Even the insurance/Medicare rates are still entirely out of line with what they are in other countries. Regardless of who ends up with the bill in this country, they're both paying too much and not getting better outcomes.
Quote from: ChriswUfGator on March 19, 2013, 07:58:35 AM
Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.
That depends on how you define malpractice costs. One study says 2%. Other studies say as much as 40%. It depends on the methodology--what costs you count--and assumptions underlying the study. The "90% of those claims" comment suggests strongly that the study you cite is counting only actual malpractice claims, and the 2% number is pretty consistent with that. When you get to malpractice insurance premiums paid, that is spread much more evenly across the entire medical industry, with more obviously attributable to docs in certain specialties. When those costs are included, the number is a lot bigger than 2%. What I've seen is about 10% when malpractice insurance premiums are included. From there you get to the costs of defensive medicine procedures that are probably unnecessary and would not be performed outside of the malpractice threat. The problem measuring them is that these are very soft costs and it is hard to nail down exactly what should or should not be included. The 40% number comes from counting everything that could possibly be driven by malpractice. A smaller number is probably more reasonable; the 40% is unrealistically high, just as the 2% is unreasonably low. I tend to think somewhere in the 10-20% range, probalby near the high end of that range, is about the best estimate we can give.
One thing for sure, medicine would be practiced very differently without the threat of jackpot malpractice claims. I am personally partial to the Swedish "no fault" approach, for several reasons, not the least of which being that it has mechanisms that will get bad docs off the street faster than in our system.