posted
Apparently there were about 1.7 million bankruptcies between 2002-2003. Now a new tudy finds that about half of those were caused due to medical costs, and that furthermore, a large portion of those people had insurance. http://www.suntimes.com/output/news/cst-nws-bankrupt02.html
So what does this mean? That we as a society are willing to ignore systemic problems like this?
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posted
Wonder how much of this is the fault of frivolous law suits which has lead to higher malpractice insurance cost which has lead to higher insurance rates which has lead to less being able to get adequate insurance.
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That's a great daisy chain, there. I'm willing to wager not as much as you think. My family was in this situation for a while (though we never had to file for bankruptcy because my father is really good at extracting services after week-long marathons of hours on the phone with insurance companies.) The point is that these people HAVE insurance. Our current sytem just doesn't work all that well.
posted
Why on earth would a bankruptcy be caused by medical expenses? (Or do people not realize that, in a crunch, they should pay medical expenses last because almost no creditor holds late medical payments against you?)
(Not that I disagree with your basic premise, though.)
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I didn't read the link, but are the bankruptcies due to the medical costs themselves, or because a medical condition made it impossible to keep working? There's a big difference between having medical insurance and disability insurance - you can get your hospital bills paid with medical insurance but if you've got a permanent disability due to accident or illness that prevents you from working and no disability insurance, then I can easily see how that might lead to bankruptcy.
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Icarus, they may not, but when you're pregnant and your insurance decides not to cover you, and your doctor won't continute treatment until someone is paying, you pay. Then you shop around for a new doctor. *mutters*
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quote:For people without much buffer between income and expenses, "a $3,000 or $5,000 loss can be a pretty catastrophic number," Morris said.
That astounds me.
Makes me extremely grateful that we've had to absorb a loss that large, and even larger, and that we've made it through okay.
I don't give thanks for my blessings nearly enough.
I have to say the article was an eye-opener, because I always figured bankruptcy due to medical costs would only be a problem with people without health insurance.
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I can see it. We have coverage, and we'll still be paying over a thousand dollars for this pregnancy. This is supposed to be good coverage, but even Wal-mart coverage was better than this. There was a level higher coverage, but it was $120 more a month. I ran the numbers and determined that we would need two other major medical incidents for it to be worth it. And then, we'd still be seriously screwed.
I'm a little irritated that our deductible gets to be deduced twice simply because of the timing. I'm a little irritated that a very routine mid pregnancy blood test is going to cost us 50 dollars when we never had to pay anything for it before. Before, we would not have been able to afford it at all. We'll absorb it all, sure. And braces too. But this year is going to be hard.
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Jay, as malpractice lawsuits are one of the great tools of capitalist efficiency, I'd answer a negative number.
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Praise God for the insurance provided from my husband's employer.
Man, Amka I'm sorry. that must be tough.
I never had to pay more than $100 for any of my three pregnancies.
They have raised our deductibles this year though, medications now cost $35 a prescription and doctor's visits are also $35, up from $25. That can get costly with four kids, and with me taking four different medications.
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Yeah, braces are expensive. My brother is going through all that stuff right now. I hope by the time I have kids, there's a cheaper way to make their teeth grow straight.
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My mother went through a huge health care crisis that lasted several years. What's more, it was mental health related, for which insurance companies are not known for their compassion. I truly believe that all insurance policies should be modified to include this line:
quote:Some procedures covered by this policy will initially be denied. This is normal, and is intended to weed out those policyholders who are not assertive enough to demand we keep our obligations. If your covered procedure, medication, or visit is denied coverage, please allow approximately two weeks of calls to the provider, the payer, the catastrophic coverage payer, and your employer in order to recieve coverage.
My dad said this was the first time he's ever voted based on a single issue, and that was health care.
At least we all have our health savings accounts, right?
Posts: 894 | Registered: Apr 2000
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posted
Ugh don't remind me. My oldest had a dental appt. today, and while she had no cavities or any problems, the dentist does want an orthodontic evaluation for her. He said her alignment is fine but her bite is off.
Don't forget glasses - I need to get my oldest in for another eye exam too. And I have no vision coverage whatsoever, and my dental is a reimbursement plan at only 50% with a 1000 maximum for the year. So, if we do need braces, it's still going to cost me a good bit.
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posted
I just went in for new glasses. They ended up costing me about 250$ out of pocket, and I have insurance. I even had a coupon!
The insurance premiums my dad pays are astronomical. I am about to switch over to my own coverage through my employer, even though it's expensive, because I can only imagine the nightmare of trying to get care without insurance.
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Insurance premiums are the main reason my husband works two jobs instead of one. If he quit his job with the fire department and went to work full time with our business, we'd make enough in gross income, but we wouldn't be able to afford family coverage as an individual. None of our employees are full time so we can't qualify as a group plan.
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Glasses prices are ridiculous. I'm wearing ones that came from $39 glasses.com. They actually cost me $20 extra because I have a high prescription, but it was better than paying $350 (I have no insurance) to replace the ones I lost.
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Padding? I have no insurance at all. But, if I worked for at my job for 2 more years I would have healh care but I hate my job and I don't want to work there for 2 more years.
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How did they cost you that? I have a very high index prescription that more or less requires me to get the ultralight carbon lenses, and I'm still only paying about $100. Our insurance is covering $150, so mine total cost about $250.
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posted
I think it would help if doc worked 40 hours a week instead of 80 hours a week. Then they might not make as many mistakes. Of course this would mean they made half as much. But the less mistakes would also help the malpractice insurance go down.
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posted
My lenses alone cost me more than your glasses! I went with the polycarb lenses, but I may have splurged for the anti-reflective ones, because I don't anticipate buying glasses again for quite a while. I also needed new frames, so it was rather expensive.
Posts: 894 | Registered: Apr 2000
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posted
The braces will probably cost us considerably more than the pregnancy, actually, but we'll spread it out over 2 years. Not payments, but two big chunks from our flex plan, which is limited to $3000 a year. We anticipate using it all up both years.
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Well, my glasses are backups, but I can't wear contacts more than 10 hours a day. I also intend to use them for quite a few years... But even the most expensive lenses from my eye doctor are only $80 each and I believe that includes anti-reflective which really is only about $10 a lense. Where are you getting your glasses?
But once I stop nursing and my prescription is stable again, and we don't have so many extra medical (cross fingers, knock on wood, etc) we are planning on intra ocular implants. I'm too high risk for lasik.
Posts: 3495 | Registered: Feb 2000
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posted
Jay, malpractice suits are not the sole reason for the high cost of health care. There are many many factors, here, not just the one single factor Bush cited because he didn't have a health care plan. The pharmaceutical industry has one of the highest profit margins in all of business. The back end administrative costs in the health care industry are a sizable percentage of what gets paid. Collective bargaining for all but the largest corporations is practically nonexistent. The government has rejected the idea of price controls, and completely ruled out any drug importation based on problems that could be addressed, but would hurt big Pharma. Direct to consumer advertising raises the price of less popular, live preserving drugs while making Pharmaceutical companies money hand over fist on their big name stuff, usually for non-life threatening conditions.
It's a really complex issue, that's affecting real people. You do yourself no favors by oversimplifying it.
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Is the anti-reflective lense a coating on the lens (which tends to make it scratch easier), or the new Crizal Alize, which is a production method that actually makes the lens itself anti reflective. Also, I need astigmatism correction, as well, which might make a difference. Of course, I may just be going to an opportunistic optometrist. There are only two in town that are in network, and the other one I refuse to go to because the last time I was there I had his first appointment of the day, and I was sitting in the chair half an hour before he pulled into his parking spot.
Posts: 894 | Registered: Apr 2000
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posted
Malpractice insurance isn't the biggest cause of skyrocketing health care costs.
For one, the administrative staffs of most hospitals equals their actual medical staff, if not exceeding it. Have you ever had to call and check on your medical bill? How many layers of administrative strata did you have to dig through to get information?
Also, as a society, we simply go to the hospital/doctor's office more than we used to. Every sniffle, ache or anxiety sends us to the hospital for treatment.
Think of all of the testing done today for even the slightest of reasons. Sometimes you can go in to have an old ailment treated at a new doctor's office and because of HIPA regulations have to go through a totally new battery of the same tests you went through before.
And how often does your doctor send you off to a specialist whereas ten years ago, the doctor would have nodded sagely and said, "Here take this for two weeks."
Now add in advertising budgets. Not for pharmaceuticals, but for actual hospitals. Billboards, radio, television, print ads. It all adds up, as does the public relations staff that produces the advertising.
But what it boils down to is this: the medical field is a business. Making money is the first order for those in charge of hospitals. And it costs money to make money. That money comes from you, the patient. Even your insurance is paid in by you.
And about insurance: if they weren't making a profit from the insurance, then the insurers wouldn't stay in business, would they?
Posts: 2848 | Registered: Feb 2003
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I don’t see anywhere that I stated it is the “sole” reason for the problem. I didn’t say the single most either. I didn’t even say the most. I was talking about things that could be changed to reduce the cost of insurance so that it would become easier to insure everyone. But of course, instead of looking at good ideas let’s attack the conservative. Yeah! That’ll work. I think another thing that would help is if instead of having useless pre-med under grad degrees you make all med school people go through the 4 year nursing program. That way they’ll know more about what they’re getting into and also what the true workers do. If they flunk out of med school they still have a useful degree. They might get into nursing and see they don’t like it and can get into something else. It makes so much sense all around. Better more rounded experienced doctors who have an appreciation of the whole system.
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posted
You may not have stated it's the sole reason for the problem, but it's the only one you mentioned. If it's not the most important factor... if it is, in fact, one of the lesser factors, why focus on it instead of the myriad costlier aspects of health care, like the administrative back end?
I'll tell you why it's been proposed. Because tort reform would help the big Business of medicine (like insurers), who we would then just have to trust to "pass on the savings" to me and you. The Pharmaceutical companies have a lot more money for lobbyists than patient advocacy groups, Jay.
Now I'm not saying that frivolous malpractice suits are not a problem. I'm saying that going after those suits to decrease the general cost to consumers of health care is a fairly ineffective response that helps the corporations far more than the consumers.
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posted
Without passing judgement on the sense behind the idea, how exactly would all doctors having nursing degrees decrease health care costs?
Posts: 894 | Registered: Apr 2000
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I'll pass judgement on the sense behind the idea. As it stands one can transfer into medicine after finishing any degree (you don't actually have to finish that first degree if your marks are high enough). By locking all would be doctors into the same premed course you aren't going to make more well rounded doctors, it just doesn't follow.
Posts: 3243 | Registered: Apr 2002
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posted
I’m not sure I’d even call it a lesser problem. It would for sure make the top ten and most likely be in the top 5. And the benefits of helping tort reform would ripple across so many areas that the other problems would be greatly reduced.
I mentioned the doctors having nurse’s degrees in the whole sense of having better doctors so that fewer mistakes would be made. More caring doctors who are in it for the patient instead of the money is what would be best for everyone. Uh oh….. I said best. Great. Do I have to clarify. Let’s see…. What would be the most best. Or is that bestest? Better? Great? Maybe I should say good. Oh who cares. Oh wait… The silly English teachers that read this do! Oh what do I care, they can’t flunk me anymore!
Posts: 2845 | Registered: Oct 2003
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posted
Wait... So the problem is avaricious doctors? All the doctors I know care most about helping their patients. Yes, they get paid a lot, but they sacrifice a lot for what they do. The huge excess of expense in the health care industry ain't going to the doctors, Jay. It's going to the businessmen, the insurance companies, and the Pharmaceutical companies. Besides, your whole premise is that a lot of the malpractice suits are frivolous. In that respect, having higher quality doctors wouldn't help at all. I frankly think we have pretty good physicians in this country, even if they didn't get their nursing degree first.
What we also have is a system that maximizes profit to the health care industry by maximizing cost and minimizing benefit to consumers. Tort reform isn't going to change that.
Posts: 894 | Registered: Apr 2000
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On glasses: Ahh, probably it is a combination of the new fangled lense and your doctor. Our doctor has a lot of competition in the area, even in network.
On health care:
I think you make many good points. Our problem, much like the SS reform problem, is what, exactly, should we do about it?
It actually benefits all of humanity to give our pharmacuetical companies enough incentive and profit that they spend lots of money on R & D. If we take away those incentives, by limiting patents or allowing the companies from outside our nation that didn't spend a dime creating the new drug to compete with our companies, our companies are less likely to spend so much effort themselves. Unfortunately it isn't the researchers we rely on, but the stock holders who will sell the company stock should it cease to become profitable. R & D will become one of the first things to get cut.
If we put pricing restraints on medical services, we have the same thing happening to therapeutical procedures. All those medical miracles that go on in the high end medical facilities eventually trickles down to everyone.
What we really need to attack is insurance, I believe. I am somewhat hesitant to put this in the hands of government. It is simply too huge and hard to manuever. Programs under it fail, often quite miserably, to serve a few in the interest of being able to serve the majority.
The impact might be less though, if it really were only insurance we were dealing with and not any interference with providers.
But I propose we can do something else, as well.
We have credit unions, non profit banking institutions that compete with banks.
Why non privately owned by the insurees, non-profit insurance companies? It wouldn't suprise me if such things exist already...
Posts: 3495 | Registered: Feb 2000
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posted
I didn’t say not let them transfer in. I said do away with useless pre-med and have them go through nursing. And how having them be nurses first would that not make them more well rounded in their field? I worked at a hospital for 6 years and there is a huge disconnect between the doc and nurses. The whole better then thou thing and what not. Doing it this way could help and make that gap less with more appreciation of them.
Posts: 2845 | Registered: Oct 2003
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posted
Sort of like extending the idea of a flex plan to the entire system? That could work. The problem there is that such a collective would necessarily be too small to exert much of a collective bargaining power. Thus, the procedures the insurance companies pay less for, the health union would have to pay more for.
As to R&D. This is, I think, where a lot of misconception is placed. A lot of the Research and Development of drugs that are necessary to our survival, like vaccines and chemotherapy, and antibiotics and really vital stuff is financed by Federal grant money! In other words, we are already paying for it through the HHS department. The pharmaceutical companies cite R&D as their big expense, but in fact they spend vast amounts of money developing things like Viagra, and then spent a significant percentage (I think it was more than ten last time I checked) of their revenue marketing these drugs direct to consumers, who then specifically request a drug that may not be right for them from their doctor. Then, if the doctor wants to keep the patient, he prescribes it (else the patient will find someone else that will.)
Cerainly R&D is important, but there seems to be an inverse relationship between the R&D money spent by Pharmaceutical companies and the severity of the condition treated by the drug. Naturally, if I come up with yet another arthritis drug, I get more customers than if I come up with something to treat a debilitating but rare disease like... scleroderma, for example. When I get home, I'll dig for an article I read recently in the New Yorker about Pharma R&D and vaccines for diseases prevalent only in developing countries.
Posts: 894 | Registered: Apr 2000
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posted
Very true, Icarus. Okay, all of us parents can sing the woes of everyday health crises. And some of us have a bit more woe.
Jay,
I disagree. That wouldn't lessen any of the 'better than thou' attitudes. It might make it even worse. I can really see them saying "I went through what you did, but I didn't quit like you did."
If it is doctor/nurse relations you are worried about, then perhaps what needs to happen are classes on intrapersonal relations between patients and coworkers. Talking about how a nurse in the hospital, simply by attending the patient regularly, may have some insight that a doctor who can only spend a few minutes with the patient can't have. How a doctor can get more out of his nurses by treating them with respect rather than disdain. This may sound silly, but weekly 'talk about it' meetings specifically meant to air out grievances between nursing staff and doctors might be useful if conducted properly.
Do we want to complain about how much the doctor's visit costs? Around 60 dollars a typical visit. If it is more, it is because there is more time involved. It all pays for nursing staff, renting the office, adminstrative staff, supplies, and medical malpractice insurance.
Jay, I forget how old you are. Do you have kids? Are you the one taking them into the doctor? Or calling them in the middle of the night? Doctors give up a LOT of personal freedom just to be doctors. They always have a pager on them. If a crisis develops with a patient while they are at their kid's play, they may very well have to leave no matter how much they promised to be there.
Compare this to the business men who make more than those doctors do.
Posts: 3495 | Registered: Feb 2000
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posted
True, about the viagra. And about silly people who go to their doctor just to get a drug they saw on TV.
I'll rant a bit about that. A while ago, I heard a radio advertisement about the purple pill. It really helped everyone. The purple pill changed their lives and made them livable again. The purple pill, apparently, was a medical miracle. But the commercial never said what the purple pill actually was. It just told you to go to purplepill.com or call some number for more information.
Perhaps we should simply ban all broadcast advertisements for prescription drugs. And limit patents to about a year when they are placed OTC.
Posts: 3495 | Registered: Feb 2000
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posted
Actually, direct to consumer advertising is a fairly recent phenomenon. Nevertheless, it's made so many people so much money that I doubt you could get rid of it. My dad introduced a resolution at the district Democratic convention to limit direct to consumer advertising, but nobody understood it. Posts: 894 | Registered: Apr 2000
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posted
Jay, I know quite a few doctors and quite a few nurses. And I'm confident that the cultural gap between them is not a primary healthcare cost. Nor, for that matter, do I believe that requiring all doctors to be nurses first would a) increase the quality of doctors b) make doctors and nurses get along better and c) reduce the current shortage of qualified doctors.
Nor do I believe that malpractice costs are the fundamental reason behind skyrocketing medical costs. In fact, I think the problem is more insidious: it's insurance. Because costs are hidden from the consumer, and those consumers unable to pay are subsidized by those who are, hospitals and pharmaceutical companies are able to conceal the true cost of their treatments from consumers. There is, in other words, not only no real competition but no real price awareness. This introduces a number of inefficiencies into the market which, sadly, are not eliminated by tort "reform."
Unfortunately, given the way modern health care is set up, I can't think of any way to introduce a freer market without seriously risking the lives of people relying on our existing controls. So my gut feeling is that, in the short term, we're better served by moving to a nationalized healthcare system where costs become a matter of standardized public record. (On the downside, this would probably prove very disadvantageous to private practicioners. But, hey, I suspect they'll go the way of the American farmer in a few years, anyway.)
Posts: 37449 | Registered: May 1999
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posted
I never said I thought that doctors and nurse relations were a cause for more expensive health care. I said doctors having nurse’s degrees in the whole sense of having better doctors so that fewer mistakes would be made. And after watching med students and first year residents for 6 years I know it is a fact that they are lost most of the time. So…. To go through something like nursing could do nothing but help in all aspects. What does pre med do? Nothing. What can you do with it? Nothing. It would probably be helpful to have first year nursing students be nursing assistants. Nothing to make someone more humble then to have to wipe a bunch of butts. Why is insurance so high? Well you can’t say malpractice doesn’t affect it. I do agree with the price awareness but disagree with nationalized health care. Canada has that and sounds like a horror story to me. I do like the idea of the ban on prescription advertising. I have a pharmacist friend who tells me about all the people who come in and want the pill that lets you run through the fields and how they want to run through the filed too. Oh well. Oops. I shouldn’t have agreed with something. That’s bad. Can’t have a conservative agree with it so now they’ll be against it.
Edit: Ok, before some numb skull says you can go to med school with it, I mean what can anyone else do with it.
[ February 02, 2005, 02:34 PM: Message edited by: Jay ]
Posts: 2845 | Registered: Oct 2003
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quote:What does pre med do? Nothing. What can you do with it? Nothing.
BTW, at nearly all (if not all) universities, there is no "pre-med" major or "pre-med" degree. It just doesn't exist.
Often students who want to go to medical school will get a BS in chemistry and/or biology, since you have to essentially take most all those classes anyway to score well on the MCAT (medical college admissions test).
What can you do with a bachelor's degree in biology? In chemistry? Well, actually, a lot.
On the other hand, my BA in philosophy wasn't likely to further my gainful employment on its own.
posted
"Canada has that and sounds like a horror story to me."
Jay. most people who say this don't really know much about Canadian health care. It's actually pretty good.
Posts: 37449 | Registered: May 1999
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posted
Yeah. Surveys show that general satisfaction with the system is actually higher than in the U.S.
Posts: 894 | Registered: Apr 2000
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Do physicians tend to be arrogant pricks? I would have to say "yes."
Are they more a hinderance than a help in their first years on the wards? Again, "yes."
Do the physicians I know who were previously nurses (3) make for some of the most practical, knowlegable, patient-oriented healthcare providers? Yes, absolutely.
Are nurses undervalued, underpaid, and treated like crap as they work pretty much tirelessly for the good of their patients? Yes. Yes, a thousand times, "yes."
Do you need to have a whole lot of additional hard science training to understand physiology, pathology, and pharmacology in order to assume primary responsibility for a patient? Yes.
[Can nurses do that? Yes. They are called Nurse Practitioners, and they can be fearsomely good at what they do. ]
Does Canada's healthcare system suck, when assessed in terms of the standard ways of comparing healthcare systems? No, it does not.
There are sad and distressing anecdotes of how the system failed for particular individuals in every healthcare system. But when you look at the system as a whole, the US does not fare better than Canada in terms of healthcare. And Canadian individuals express more satisfaction with their personal experience of their own system than do Americans. (Same for Kiwis, Brits, and Aussies.)
This is likely to be in part due to a generally healthier population. However, the investment in preventive medicine and continuity of care and records has a lot to do with that aspect, regardless. And certainly it is not a given that the US system would rank better on standard assessment scores even if there was a healthier baseline population to start with. You'd have to argue long and hard to establish that -- you don't get to just assume it.
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I went with the polycarb lenses, but I may have splurged for the anti-reflective ones, because I don't anticipate buying glasses again for quite a while. I also needed new frames, so it was rather expensive.
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Nor, for that matter, do I believe that requiring all doctors to be nurses first would a) increase the quality of doctors b) make doctors and nurses get along better and c) reduce the current shortage of qualified doctors.![[ROFL]](graemlins/rofl.gif)
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