Healthcare in the US--a 2020 Thread (1 Viewer)

[Terminalxylem]

The same article mentions the fear of defensive medicine drives up costs.  Tort reform would go a very long way in cutting unnecessary tests/costs.

I still think cutting physician pay will discourage people from going into the field--when we already don't have enough. 

We don't have enough primary care physicians because the training spots are artificially limited. And we skew salaries too much toward proceduralists. There are more than enough qualified applicants. That being said, even when you account for educational debt, US physicians earn far more than their international peers.

Reducing physician pay is a part of the puzzle, but probably not the most important IMO. Among other things, I think we should focus on more realistic end-of-life expectations, to reduce the ginormous sums we spend on frivolous care. And universal single payer (likely the gov't) would reduce a lot of unnecessary middle people like coders/billers/insurance admin. You can probably get rid of a bunch of highly paid hospital admin while you're at it. Big Pharma/device manufacturers also need to be reigned in.

Tort reform seems like a good idea, but it hasn't panned out in reducing healthcare cost TMK.

ETA Sorry, a little late to this thread. I see you've already addressed several of my points.

 

[RCon]

Again, at the current rates, Medicare for all isn’t sustainable.

Hospitals can’t pay their own bills at that reimbursement rate.  

How do we solve that problem?  Increase rates or government subsidies.

Which ultimately mean even more taxes. For us or the wealthy.

Keeping the Lights On: Why Are U.S. Hospitals Closing?

While each hospital under threat of closure deals with problems unique to its location, their underlying problem is singular: not enough money. The biggest factor, the professors said, is the mix of payers. Hospitals need enough commercially insured patients with private polices to offset the uninsured patients, because Medicaid and Medicare do not reimburse 100% of expenses.

Very late to this thread, but something caught my eye in these back to back posts.  I'm seeing this idea that Medicare payments currently don't cover costs.  That is, if every procedure was paid by Medicare, the hospitals would lose money.  There's a piece there that bothers me.

When we talk about taxes and the deficit, fiscal conservatives tend to argue that the problem isn't lack of revenue, it's too much spending.  Yet, here, those same people are making the opposite argument.  Rather than raise prices to Medicare-covered procedures (i.e. revenue), why aren't we talking about reducing costs (i.e. spending)?  How much does a hospital spend on C-level executive pay?  How much do we spend on brand-name drugs covered by patents, while other countries pay significantly less for the same pills?

https://www.healthline.com/health-news/hospital-ceo-pay-rises-while-americans-in-medical-debt#1

https://www.beckershospitalreview.com/rankings-and-ratings/18-of-the-highest-paid-ceos-in-healthcare.html

https://www.forbes.com/sites/adamandrzejewski/2019/06/26/top-u-s-non-profit-hospitals-ceos-are-racking-up-huge-profits/#6b0c659019df

Here’s how executive compensation breaks down at the 82 largest non-profit hospitals using the IRS 990 informational returns and auditing the latest year available:
* 13 organizations paid their top earner between $5 million and $21.6 million;
* 61 organizations paid their top executive between $1 million and $5 million;
* Only 8 organizations paid their top earner less than $1 million (which proves it’s possible).

Based in Phoenix, Arizona, Banner Health* paid out $34 million to just two executives. The president of Banner made $21.6 million and an executive vice-president made $12.4 million.

Even after paying lavish salaries, these non-profit hospitals had enough left over to add nearly $40 billion to their bottom-line.

We found that the assets, investments and bank accounts at these charitable hospitals increased by $39.1 billion last year – from $164.1 billion to $203.2 billion. That’s 23.6 percent growth, year-over-year, in net assets. Even deducting for the $5.2 billion in charitable gifts received from donors, these hospitals still registered an extraordinary 20.5 percent return on investment (ROI).

Last year, these 82 hospitals spent $26.4 million on lobbying to defend the status quo. Because government money and charitable donations can’t be spent directly on lobbying, these hospitals used the payments from patients to lobby government to preserve their market position.

 

[Terminalxylem]

Very late to this thread, but something caught my eye in these back to back posts.  I'm seeing this idea that Medicare payments currently don't cover costs.  That is, if every procedure was paid by Medicare, the hospitals would lose money.  There's a piece there that bothers me.

When we talk about taxes and the deficit, fiscal conservatives tend to argue that the problem isn't lack of revenue, it's too much spending.  Yet, here, those same people are making the opposite argument.  Rather than raise prices to Medicare-covered procedures (i.e. revenue), why aren't we talking about reducing costs (i.e. spending)?  How much does a hospital spend on C-level executive pay?  How much do we spend on brand-name drugs covered by patents, while other countries pay significantly less for the same pills?

https://www.healthline.com/health-news/hospital-ceo-pay-rises-while-americans-in-medical-debt#1

https://www.beckershospitalreview.com/rankings-and-ratings/18-of-the-highest-paid-ceos-in-healthcare.html

https://www.forbes.com/sites/adamandrzejewski/2019/06/26/top-u-s-non-profit-hospitals-ceos-are-racking-up-huge-profits/#6b0c659019df

Between hospital administration and insurers, there's a whole lot of people contributing to cost but not directly participating in actual healthcare. 

 

[CletiusMaximus]

Both David Wichmann, UnitedHealth Group's CEO, and Stephen Hemsley, its former CEO and executive chairman, made over $50 million last year in salary, bonus and stock option compensation.

 

[The Z Machine]

Both David Wichmann, UnitedHealth Group's CEO, and Stephen Hemsley, its former CEO and executive chairman, made over $50 million last year in salary, bonus and stock option compensation.

Look, it's what the market will bear.  Capitalism, bro.

 

[Mookie]

Was just told by my employer that wages will be frozen for next fiscal year (happy to have a job), and the cost of our health insurance (covered for me, but I pay 1/2 for my wife and two kids) will go up 10% over last year.  How's that Republican plan coming?

 

[BladeRunner]

Look, it's what the market will bear.  Capitalism, bro.

Seriously, why don't you move to Cuba or Venezuela or some other Socialist state that you think is better?

You guys that rail on the US why do you even bother to spend one more minute on it's soil?  Move to a country that suits your ideology better.

I mean, I KNOW why you won't, but I'd like to hear it directly from you as to why you're still here.

 

[The Z Machine]

Seriously, why don't you move to Cuba or Venezuela or some other Socialist state that you think is better?

You guys that rail on the US why do you even bother to spend one more minute on it's soil?  Move to a country that suits your ideology better.

I mean, I KNOW why you won't, but I'd like to hear it directly from you as to why you're still here.

Why don't we all work to change the massive wealth gap in this country?  What about providing a proper social safety net?

Why are you against those things?

 

[BladeRunner]

Why don't we all work to change the massive wealth gap in this country?  What about providing a proper social safety net?

Why are you against those things?

We already have that.  

I say the first thing we do about the wealth gap is take most of your money and distribute it.  How about that? We start with you?

 

[The Z Machine]

We already have that.  

I say the first thing we do about the wealth gap is take most of your money and distribute it.  How about that? We start with you?

Start with me and everyone else at the same time please. Oh and scale it based on current wealth.

 

[Tau837]

Start with me and everyone else at the same time please. Oh and scale it based on current wealth.

This isn't the thread to get into debates over wealth redistribution. Take it to another thread.

 

[BladeRunner]

Start with me and everyone else at the same time please. Oh and scale it based on current wealth.

Uhm...no.  We'll start with the guys that want to pull this Socialist crap on everyone else.  Maybe once you actually suffer yourself you'll see what Socialism really brings to the table - suffering, misery and death.

No thanks.  I'd just rather you socialists practice what you preach for a while.  Maybe we just deport all of you guys to your favorite socialist country of your choice, you live there for a decade and then we might listen to you if all goes well (pro tip: it won't).

 

[Amused to Death]

Well, at least until the Trump administration is successful in dismantling it during a pandemic.

How do you get health care coverage if you lose your job?

From Fox News:

If you don’t qualify for Medicaid, you may be eligible to get a plan through the Affordable Care Act marketplace. Individuals whose expected 2020 income falls between 100 percent and 400 percent of the federal poverty level (for individuals, that’s $12,490 to $49,960) can qualify for subsidies on their insurance premiums.

 

[Bottomfeeder Sports]

Sure it is a token gesture right now but the bill the House democrats pushed through today would build on the ACA in this fashion-

• The bill would eliminate the 400 percent threshold, saying for the first time that no one would be required to pay more than 8.5 percent of their income on the most popular tier of marketplace health plans.
  
• For 14 states that have not expanded the program, the bill would reduce federal funding for traditional Medicaid. It would also add an inducement, paying for the entire initial cost of an expansion — as the law did when expansions first were allowed in 2014.
  
• Medicaid also would guarantee that all women in the program would stay eligible for coverage for a year after they give birth — a step to address the nation’s high rates of medical problems and deaths among new mothers.
  
•  the bill would undo a rule that allows skimpy insurance plans to be sold for up to 12 months, returning them to a three-month maximum.
  
• It would provide $100 million a year for outreach and enrollment assistance to encourage consumers to sign up for ACA health plans — activities the administration has slashed.
  
• The bill also includes a longtime Democratic goal of allowing federal health officials to negotiate the price of drugs under Medicare
  

Cut and paste from this link

 

[pollardsvision]

Uhm...no.  We'll start with the guys that want to pull this Socialist crap on everyone else.  Maybe once you actually suffer yourself you'll see what Socialism really brings to the table - suffering, misery and death.

No thanks.  I'd just rather you socialists practice what you preach for a while.  Maybe we just deport all of you guys to your favorite socialist country of your choice, you live there for a decade and then we might listen to you if all goes well (pro tip: it won't).

This argument started over a link about a couple of health insurance execs from the same company earning $50 million last year.

American citizens and American businesses pay a boatload of money for healthcare each year. Do you really like the idea of health insurance companies syphoning off so much our hard earned money off the top?

The cost to bring healthcare to people is high enough. I don't understand the need to stuff the pockets of middlemen along the way.

Why are you so in love with such a system?

 

[urbanhack]

https://www.bloomberg.com/news/articles/2022-03-04/half-of-insured-americans-owe-medical-debt-boosted-by-covid

This isn't sustainable. 

 

[Sabertooth]

https://www.bloomberg.com/news/articles/2022-03-04/half-of-insured-americans-owe-medical-debt-boosted-by-covid

This isn't sustainable. 

It just isn’t.  It’s just not going to work with a for profit model.  

 

[Snotbubbles]

And universal single payer (likely the gov't) would reduce a lot of unnecessary middle people like coders/billers/insurance admin. You can probably get rid of a bunch of highly paid hospital admin while you're at it. Big Pharma/device manufacturers also need to be reigned in.

Dealing with this right now.  Went to a hospital to get an x-ray on my thumb.  Have made 3 different payments to the hospital and they continue to say I still owe them money.  Is it so hard to just get one itemized bill that covers all services?

No to the high paid hospital admin.  My wife just got promoted from ER floor nurse to assistant manager of ER (and is in line to become the manager in the next 24 months).  LOL.

 

[The Commish]

https://www.bloomberg.com/news/articles/2022-03-04/half-of-insured-americans-owe-medical-debt-boosted-by-covid

This isn't sustainable. 

It just isn’t.  It’s just not going to work with a for profit model.  

Been saying this for years. This is only going to get worse as they take funding away for the things they are still paying for, though in the current model I think it needs to be done.  Easy for me to say.  I have insurance. 

 

[Sabertooth]

Been saying this for years. This is only going to get worse as they take funding away for the things they are still paying for, though in the current model I think it needs to be done.  Easy for me to say.  I have insurance. 

It’s simply not a viable option.  You can’t keep siphoning money off people and expecting them to pay their bills.