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Old May 8th, 2013, 04:45 PM   #1
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Staggering medical costs in U.S.(Health care reform)

Most powerful interest group in U.S.

NRA and AMA(American Medical Association)

The reason why numerous Health Care reform of the 20th century failed.

New hospital data on costs

No wonder some go to Canada to get treated

Americans, don't get sick, if only for financial reason
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Old May 8th, 2013, 09:20 PM   #2
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Re: Staggering medical costs in U.S.

SINGAPORE - Singapore is expected to see some 850,000 foreign patients bringing in US$3.5 billion (S$4.31 billion) worth of revenue from medical tourism this year, after foreign patient numbers grew at a compound annual growth rate of 15 per cent over the last three years, according to a report.

- By Nisha Ramchandani Friday, Oct 05, 2012 The Business Times



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Old May 8th, 2013, 11:34 PM   #3
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Re: Staggering medical costs in U.S.

First of all, the AMA is an association for Doctors and medical students.
The prices you see are from documents called a chargemaster that each hospital has.
Those prices are for hospital fees, not physician fees so AMA has nothing to do with this.

Also, those fees are not what hospitals get reimbursed for those services. CMS reimburses a fraction of those prices. Private insurers typically reimburse a bigger fraction than CMS (Medicaid/medicare). That being said, I have little sympathy for Hospitals.
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Old May 9th, 2013, 01:33 AM   #4
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Re: Staggering medical costs in U.S.

Its not so much doctors that are expensive. (They are very expensive vis a vis the rest of the world) but the entire medical industry is overpaid. Nurses, radiologists, pharmacists etc. have a even greater premium in America vis a vis the rest of the world.
For example in India a good surgeon would get 200K whereas a good American surgeon would get 600 700 k. But the difference between pharmacists , nurses etc is more than 10 times the salary of Indian medical staff. Even adjusting for cost of living in America this is highly expensive vis a vis other jobs in America. Hence medical care feels so expensive to other workers. Other reasons include us paying the cost of developing drugs for the whole world and the rest of the world freeloading on it.
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Old May 9th, 2013, 02:39 AM   #5
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Re: Staggering medical costs in U.S.

http://www.newyorker.com/reporting/2...a_fact_gawande

The New Yorker actually wrote about this in detail in 2009. If you're interested in health care, it's an extremely interesting analysis! Atul Gawande is an excellent medical journalist -- I recommend his "Cheesecake Factory" article from TNY as well.

Basically how medical billing works right now is that doctors are paid per procedure they order (fee for service) NOT per patient. That incentive coupled with defensive medicine (not wanting to be sued for malpractice) often leads to unnecessary tests or procedures. The ACA has clauses that are trying to encourage doctors to provide better care for less money. For example, paying doctors a set amount to treat a certain illness based on what they've ascertained an "average" amount would be. ACOs (Accountable Care Organization) are also being set up, which again encourage better care for less money.

Another reason medical costs are so high is the entire system that's set up -- think about how much money is spent just on insurers, medical billing, marketing, etc. A single payer system would have helped cut costs since the middle man is out of the picture, but it A) never would have passed Congress and B) the insurance lobby would have fought tooth and nail. Health care reform is actually what Republicans wanted in the 90s as an alternative to Clinton's universal health care before they started sliding more and more towards the right...
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Old May 9th, 2013, 03:45 PM   #6
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Re: Staggering medical costs in U.S.

Quote:
Originally Posted by Expat View Post
Its not so much doctors that are expensive.
That is one and only reason. Average doctor is paid 5 times an average worker is paid in USA. In any country with any kind of resemblance of universal healthcare that ratio does not exceed 2.5. Until that is changed, any attempt at real healthcare reform is futile.
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Old May 9th, 2013, 06:10 PM   #7
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Re: Staggering medical costs in U.S.

I know people like to reinforce to themselves what they think they know, but I'll say it again:
The link attached has nothing to do with physician services. They are for Hospital fees (which are HUGE compared to physician fees).

Medical provider fees account for less than 20% of US healthcare expenditure. Fact. Obviously there is a LOT more to medical costs in the US than how much physicians are paid.

Also you would be surprised how much (or little) physicians are paid. A knee arthroscopy for instance can pay as little as $200 for the orthopedic surgeon. The anesthesiologist would get his fee as well, depending on what kind of block was used but it won't be much more than the above.

Now, if this was done IN A HOSPITAL you would have to pay hospital fees, and this is where it starts to get expensive. In an outpatient center, it will be WAY cheaper.
Doctors by law are not allowed to own hospitals, so let the multimillionaire Hospital administrators be the subject of your ire, not the hardworking docs out there.

Healthcare is expensive in this country because of the massive amounts of bureaucracy involved in healthcare delivery.

Quote:
Originally Posted by Expat View Post
For example in India a good surgeon would get 200K whereas a good American surgeon would get 600 700 k.
A general surgeon making 700k a year either works in a region with a good payer mix (basically all private insurance, upper middle class neighbourhood, self-pay etc) and/or has ancillary sources of revenue (owner of his practice, probably owns outpatient radiologic center etc)
700k is on the high side of the general surgeon compensation bell curve.
Also, how much malpractice insurance does that surgeon have to pay, compared to Indian doctors? US physicians pay the highest malpractice premiums in the world, and US surgeons are even higher.

Quote:
Originally Posted by .ivy. View Post
http://www.newyorker.com/reporting/2...a_fact_gawande

The New Yorker actually wrote about this in detail in 2009. If you're interested in health care, it's an extremely interesting analysis! Atul Gawande is an excellent medical journalist -- I recommend his "Cheesecake Factory" article from TNY as well.
Atul Gawande is a brilliant general surgeon and good writer and I have read his earlier books 'good' and 'better'.
I read the Cheesecake Factory article but didn't fully agree with it. You cannot reduce medicine to algorithms because it is a personal service industry. Maybe for certain surgical procedures like a routine cholecystectomy or appendectomy it will work, but it doesn't quite work for internists dealing with patients with chronic illnesses and comorbidities.

One should be careful what they wish for, when suggesting the medical industry appropriate the Cheesecake Factory's delivery model.

Quote:
Originally Posted by .ivy. View Post
Basically how medical billing works right now is that doctors are paid per procedure they order (fee for service) NOT per patient. That incentive coupled with defensive medicine (not wanting to be sued for malpractice) often leads to unnecessary tests or procedures. The ACA has clauses that are trying to encourage doctors to provide better care for less money. For example, paying doctors a set amount to treat a certain illness based on what they've ascertained an "average" amount would be. ACOs (Accountable Care Organization) are also being set up, which again encourage better care for less money.
There is no evidence that ACOs will be better than what we have now. On the contrary ACOs are eerily similar to HMOs of the 90s which flopped.
There are a number of untested models in the ACA (ACOs, PCMH) supposed to 'reform' our healthcare. However, it's a hope and pray it works situation as these have not been tested in a sample US market to see if it works.

Also several countries with less expensive care, operate on a fee for service payment model so to say that that's why fees are high begs the question.

Quote:
Originally Posted by .ivy. View Post
Another reason medical costs are so high is the entire system that's set up -- think about how much money is spent just on insurers, medical billing, marketing, etc. A single payer system would have helped cut costs since the middle man is out of the picture, but it A) never would have passed Congress and B) the insurance lobby would have fought tooth and nail.
This is the main reason. Medical billing is A MESS! I mean it is fucked up beyond all recognition.

Quote:
Originally Posted by ys View Post
That is one and only reason. Average doctor is paid 5 times an average worker is paid in USA. In any country with any kind of resemblance of universal healthcare that ratio does not exceed 2.5. Until that is changed, any attempt at real healthcare reform is futile.
Did not realize you have a socialist side. Take it back to Russia
Average doctor is paid way more than an average US worker because they are not average US workers. You of all people should recognize that you want to incentivize the best to such professions.
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Old May 9th, 2013, 08:34 PM   #8
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Re: Staggering medical costs in U.S.

Quote:
Originally Posted by semprelibera View Post
I know people like to reinforce to themselves what they think they know, but I'll say it again:
The link attached has nothing to do with physician services. They are for Hospital fees (which are HUGE compared to physician fees).
I can attest to that fact! I had a procedure done in the hospital because my GP didn't have the proper equipment at his facility to do it. What the hospital charged me was over 3x what my GP charged me for the initial visit, actual procedure, and the check-up combined.
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Old May 9th, 2013, 10:52 PM   #9
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Re: Staggering medical costs in U.S.

Quote:
Originally Posted by semprelibera View Post
First of all, the AMA is an association for Doctors and medical students.
The prices you see are from documents called a chargemaster that each hospital has.
Those prices are for hospital fees, not physician fees so AMA has nothing to do with this.
"the greatest failure of American Association for Labor Legislation(AALL), was the campaign for. compulsory health insurance. ...Chief opponent was the organized medical profession itself...Health insurance was damned as a German conspiracy or a Bolshevik one...AMA had emerged from this struggle fully and actively conscious of its political potency; it could be counted upon to oppose, powerfully, any legislative proposal which might affect..the private-entrepreneurial nature of American health care delivery"

pp. 441, Kenneth S. Davis, "FDR; the New Deal Years"
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Old May 9th, 2013, 11:20 PM   #10
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Re: Staggering medical costs in U.S.

From FDR to Obama;

American Medical Association Trying To Torpedo Health Care Reform Again

"Just days before President Barack Obama is set to address the American Medical Association to pitch its members on his vision for health care reform, the 250,000-member physician group announced it would oppose a major component of that effort.

On Wednesday night, the New York Times reported that AMA was "letting Congress know" that it would resist a public plan for health insurance coverage.


Politically, the revelation could be a potentially significant blow to progressive health care reform advocates, who contend that a public option is the best way to reduce costs and increase insurance coverage. AMA has the institutional resources and the prestige to impact debates in the halls of Congress.

Historically and philosophically, however, AMA's opposition is hardly newsworthy. Despite a lofty reputation and purported commitment to universal coverage, AMA has fought almost every major effort at health care reform of the past 70 years. The group's reputation on this matter is so notorious that historians pinpoint it with creating the ominous sounding phrase "socialized medicine" in the early decades of the 1900s.

"The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system," Jonathan Oberlander, a professor of health policy at the University of North Carolina, told NPR in a 2007 interview. "They also used it to mean things in the private system that they didn't like. So, at one point, HMOs were a form of socialized medicine."

Indeed, the role played by AMA throughout health care reform battles past has often been primarily as the defender of the status quo. In 1935, fears of an AMA backlash helped persuade Franklin Roosevelt's advisers to drop a health care article from the Social Security package -- fearful that the opposition would sink the legislation altogether.

Concerned about government restriction on and oversight over surgical activities -- not to mention the loss of physician income -- the group deployed the "socialized medicine" argument to undermine Harry Truman's effort at a national health care system years later.


In 1961, AMA organized a campaign to block Medicare. Titled "Operation Coffeecup," the effort insisted that the government-sponsored system would lead to a varying form of totalitarianism. For a spokesman, the group turned to Ronald Reagan, who lent his famous actor's voice to a 10-minute plus recording.

"One of the traditional methods of imposing state-ism or socialism on a people has been by way of medicine," said the then-future president. "It is very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it."


During the most recent effort at reform -- the Clinton administration's go at it in the early '90s -- AMA found itself, once again, the spoiler. The group, worried about cost-control measures, poured $3 million into defeating Hillary Clinton's proposal. Perhaps as significantly, it lent its name (and the prestige of its members) to the political opposition. In 1995, AMA endorsed then-House Speaker Newt Gingrich's Medicare Preservation Act. It was interpreted, at the time, as a patently political ploy - an effort to align with the party that held the keys to legislative power.

The same cannot be said of the American Medical Association's decision to oppose a public plan in the current health care reform quarrel, in which the Obama White House holds the vast majority of political power. Indeed, up until Wednesday, AMA, like most other private players, had kept its powder dry.

So why speak up now? The group cited impossible-to-avoid policy disagreements.

"The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs," read an organizational statement to the Senate Finance Committee. "The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans."

Without private insurers in the market, the statement added, "the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers."

On this front as well, AMA's critics have room to scoff. Indeed, in mid-February, the Commonwealth Fund put out a report on the most cost-effective ways to revamp the health care industry. The public plan, it concluded, "plays a central role in harnessing markets for positive change" by lowering premiums for many Americans by, potentially, $1,000 a year. In addition, the Commonwealth Fund added, a public plan would help decrease the number of uninsured in the country from "an estimated 48 million in 2009 (16 percent of the U.S. population) to 4 million by 2012." "
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Old May 9th, 2013, 11:24 PM   #11
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Re: Staggering medical costs in U.S.

SiCKO: Ronald Reagan On the Evils of Socialized Medicine
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Old May 10th, 2013, 01:46 PM   #12
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Re: Staggering medical costs in U.S.

This could become a sticky thread considering the magnitude of Health and Medicare mega 'spending' budgets, and if we club them with Social spending then those three will put the Defense Goliath to shame

Nothing wrong with spending. It's very essential.

However, staggering medical costs are due to wasteful spending, excess billing, corruption, red tape (say DHS/HHS), scams, frauds and importantly lack of sincerity towards effective spending. If someone tells you there is no corruption in the US then it's a big lie. People don't get math. %-wise quite less compared to corrupt but on $-wise beats many nations. Plus, all these mega-spending contributing in a big way towards $1+ trillion deficit each year

Perhaps if members regularly watch TV hearings of Oversight and Government Reform committee (chaired by Rep. Darrell Issa) then they will be shocked. Pick any vertical spending, one can observe the 'wastage' ranging from tens of billions to hundred plus each year!

Well, ACA will effect me too (say Health Insurance). Keeping a 'tab' on permanent/temp count is a must.
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Old May 10th, 2013, 02:43 PM   #13
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Re: Staggering medical costs in U.S.

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Originally Posted by semprelibera View Post

Did not realize you have a socialist side. Take it back to Russia
Average doctor is paid way more than an average US worker because they are not average US workers. You of all
people should recognize that you want to incentivize the best to such professions.
DId I say it is bad? No, I just said that for as long as this unusually high ratio exists, all hopes for universal healthcare are pipedreams. Only that. For what it's worth, I am against universal healthcare, especially the freaky way it is attempted in USA.
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Old Oct 16th, 2013, 01:10 AM   #14
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Re: Staggering medical costs in U.S.(Health care reform)

"Hill-Burton Act(1946), backed by AMA, mainly benefited doctors, hospital administrators, and the rising network of medical insurers"

Patterson's 'Grand Expectations", p.143
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