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Old 21st August 2019, 04:24 PM   #41
xjx388
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Originally Posted by Darat View Post
You are right such costs are known, for instance for a NHS (England) GP visit the cost is about £30.
Thanks!

For my clinic, our average cost per visit is around $95. The primary cause of that cost is administrative burden: Cost of billing staff, billing software, compliance costs, the delay in waiting for the money, staff to handle the extra documentation, etc.

If all our patients were self-pay, we could eliminate most of our overhead. We might be able to charge $75 per visit or less in such a scenario. There are cash-only clinics that serve the uninsured here that charge only $45 -although they are staffed by NPs with no doctor on site usually.

Let's be real. The cost of providing basic physician services should be ridiculously low. The reason it isn't has mostly to do with the cost of education and government regulation and very little to do with physician greed.
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Old 21st August 2019, 04:28 PM   #42
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Originally Posted by The Norseman View Post
Okay!

So my daughter (age 23) and I (age irrelevant ) recently went on a week-long cruise to Alaska.

Second day, she got quite ill and was basically bed-ridden for 20-something hours before I decided she should see the on-board doctor. The hesitation was, of course, due to financial reasons.

We went and she got checked out. I questioned every procedure first and made it quite clear we were having to pay out of pocket. The doc showed the evidence and suspected my daughter of having appendicitis. They couldn't do much, but with her temperature, complaints of abdominal pain, absence of other symptoms and somewhat high WBC... the doc insisted that we be disembarked in the next town to be seen in the ED. The next morning. In the meantime, she was given some IV antibiotics on the ship; the first bag leaked all over the bed before they realized it and no one could say how much medicine she got; the doc decided it wouldn't hurt to give a second full bag. The nurse on the ship was massively (in my mind) incompetent and had to stick her three times to get a good vein for the IV line.

So, she spent the night on board and claimed feeling better the next morning but once again the doc insisted. With no real choice, we had to leave.

In the Ketchikan hospital, she had an ultrasound and CT and was given fluids. After about five hours, we were cleared to rejoin the ship.

Total bill from all agents involved: about three thousand dollars.
My daughter's mother was able to get a month's coverage through COBRA, but still had a $1,500 deductible which would have to be paid out of pocket regardless.

The ship bill was around $1,200; she was charged for the two attempted sticks at about $18 a piece as well as the first bag of antibiotics which had drained onto the gurney. We were also charged $250 for the fees for disembarkation.

The CT was something like $800 as was the ultrasound. Other charges too I don't recall.

Turns out that she wasn't suffering from anything other than probable food poisoning or a similar malady.

The whole time we were massively pressured to having all these tests, most especially the "oh this is standard" pregnancy test which my daughter and I both refused at first until finally relenting in the ED. Oh, it looked like we were charged for the pregnancy test by the ship-board doc, even though they pushed it there and we both flatly said no. It was a urinalysis so it was pretty easy to figure out if it were actually done or not, so I'm quite confident it was just another ******** charge that they hope to sneak by in the moment and make it much harder to fight later on.

And that, in a nutshell, is the typical and standard method of healthcare in the US.
I don't agree that that is typical and standard in the US. You were on a cruise ship; those fees are going to be ridiculously high and it has nothing to do with the US system.

~$1800 for an ER visit with a CT sounds about right, but that cruise ship doc was extremely overpriced.
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Old 21st August 2019, 04:31 PM   #43
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Originally Posted by Seismosaurus View Post
Okay, general thoughts.

Seems like it would be on the order of $100-several hundred or so, which is actually less than I'd expected.

Other random thoughts from reading through the thread...

Yeah, obviously there are going to be advantages and disadvantages to any system. I hadn't considered how much the US system must spend just because it is about money, but that's sure to be a significant cost. And sure, there's a motivation there for doctors to press patients into unnecessary procedures.

But then with the NHS, overall funding is a matter of politics - which doesn't necessarily align with 'what's best for the patient' either.

From talking to people the biggest obvious advantage of the US system over the NHS seems to be the speed. For example, my dad just got an eye test recently. He's a stroke victim, and has compromised vision as a result. They found an issue and referred him to his GP, who referred him to an eye specialist. Total time from initial test to his appointment with the specialist is 122 days. It's a non-urgent thing, so it's not like he's going blind as he waits or anything; it's an inconvenience is all. But, again, on anecdotal evidence, this kind of thing goes way faster in the US.

My overall impression is that US healthcare is great... if you have good medical insurance, and/or are rich. And awful if you don't/aren't. NHS care is damn good, but slow, and the same for everyone.

Of course in the UK there's nothing to stop you paying out for private medical insurance or private healthcare if you want to skip those NHS waiting lists. Though you don't get a break on your national insurance costs if you do that, so you essentially pay double.

Thanks for the responses, all, it's been an interesting read so far.
How so? If you use private insurance to skip waiting, don’t you also use your public system to access GPs and so on? You pay extra for private health insurance, but isn’t that for extra and speedier services, with basic services paid through your taxes?
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Old 21st August 2019, 04:34 PM   #44
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Originally Posted by Seismosaurus View Post
So, one nurse visit, one GP consult, couple of boxes of pills. If I'd been American, or other places without an NHS equivalent, and assume no health insurance, what kind of cost would you be looking at for that? Hundreds? Thousands? More?

With absolutely no insurance, probably about $200 for the medical visit and between $40 and $80 a month for the medication based on how careful a shopper you are.

With most insurances, Between $20 and $50 for the medical visit and $20 a month for the medications.

With Medicare in the US, free medical visit and up to $20 a month for the medications (except for the donut hole and catastrophic care which, frankly, it's easier to die and reincarnate in the future than try to understand).
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Old 21st August 2019, 04:59 PM   #45
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Originally Posted by Loss Leader View Post
<snip>
With Medicare in the US, free medical visit and up to $20 a month for the medications (except for the donut hole and catastrophic care which, frankly, it's easier to die and reincarnate in the future than try to understand).
Yes.

For the type of case described in the OP, a Medicare patient in the US, the cost is normally $0, or close to $0. The donut is, on its face, straight-forward; when you try to get something like a realistic estimate of what you will have to pay for a new prescription, you may find yourself in labyrinth of barely understandable size (hint, it’s vast).
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Old 21st August 2019, 05:02 PM   #46
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Originally Posted by TragicMonkey View Post
The self-pay paradox is that some uninsured get charged less by some providers, out of pity and reason, whereas other providers will charge the uninsured more because the insured are getting discounts negotiated by their insurers.
Something I just read indicated the big numbers are for the benefit of rich people. Which means, I think, that individuals could offer to settle up with the hospital for less, but you might not feel up to it immediately after, say, a quadruple bypass.

Originally Posted by TragicMonkey View Post
The system may make business sense but that doesn't mean it makes medical sense. I've worked in healthcare for a while now, and the broad consensus on the provider side is we'd just like to earn decent livings and make enough business-wise to stay in operation and provide good healthcare to the patients. When I was on the insurer side the ideal was to make money, and if people got good healthcare that was a pleasant bonus.
They need to pay all those people who they employ to reject claims.

Any rational reform would include a plan to transition from our current system to something more like what exists in other rich countries. The ACA tried to do that, but since Republicans disavowed their own plan there's no mechanism to go in that direction.
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Old 21st August 2019, 05:05 PM   #47
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Originally Posted by JeanTate View Post
Yes.

For the type of case described in the OP, a Medicare patient in the US, the cost is normally $0, or close to $0. The donut is, on its face, straight-forward; when you try to get something like a realistic estimate of what you will have to pay for a new prescription, you may find yourself in labyrinth of barely understandable size (hint, itís vast).
There are still premiums - $130 to $270 per month depending on income. And a roughly $1,000 deductible per hospitalization.
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Old 21st August 2019, 06:17 PM   #48
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I just can't get my head around the fact that you yanks won't do UHC.
In simple terms, we British pay around 11% of our gross salary and that covers us for all social welfare needs. Lost your job, here's your dole money. In a coma, your hospital bill is covered. Why do you not see the benefit of that kind of system? There is no downside.
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Old 21st August 2019, 06:25 PM   #49
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Originally Posted by lionking View Post
How so? If you use private insurance to skip waiting, don’t you also use your public system to access GPs and so on? You pay extra for private health insurance, but isn’t that for extra and speedier services, with basic services paid through your taxes?
I was thinking of somebody using private medical services exclusively. There are private GPs, private hospitals, etc so you can do all your medical stuff without the NHS, I think. But I guess you could use the NHS for routine stuff and only use private insurance to get faster treatments when needed. A bit of both worlds since you're paying for both.
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Old 21st August 2019, 06:28 PM   #50
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Originally Posted by welshdean View Post
I just can't get my head around the fact that you yanks won't do UHC.
In simple terms, we British pay around 11% of our gross salary and that covers us for all social welfare needs. Lost your job, here's your dole money. In a coma, your hospital bill is covered. Why do you not see the benefit of that kind of system? There is no downside.

Something to do with westward expansion and self-made millions.

When you start with a basically empty country (except for the people who were living here), the idea that there are resources for anyone willing to take them is very powerful.

I would say that the whole thing was over by WWI, but then Europe destroyed itself twice in a row and we got to move right into refilling that hole.

The philosophy is horrifyingly outdated (and pretty racist), but it is uniquely American. "You are your own key to success and to hell with the other guy."
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Old 21st August 2019, 06:30 PM   #51
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Originally Posted by welshdean View Post
I just can't get my head around the fact that you yanks won't do UHC.
In simple terms, we British pay around 11% of our gross salary and that covers us for all social welfare needs. Lost your job, here's your dole money. In a coma, your hospital bill is covered. Why do you not see the benefit of that kind of system? There is no downside.
Because that would be socialism! We didn't get together as a people to pool our resources and work together for our common good in programs administered by a popularly elected government in order to be socialists!
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Old 21st August 2019, 09:00 PM   #52
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Originally Posted by Dave Rogers View Post
At the risk of asking a personal financial question, what sort of annual cost would that represent for medical insurance?

Dave
I'd have to check a pay stub to be sure. I get the insurance through work. I have the family plan (Employee + 2 or more dependents) and I think my premium is around $250/month. Not sure about employer portion. I think my employer pays the whole thing.

I have pretty good insurance. I'm told it's better than the plan the insurance company employees get. Obviously, this is not typical.

Basically, $20 copay for most visit, $30 for specialists. ER $250 copay, (convenient care is $20) and if hospitalized, $250 copay per admission. Prescriptions are $8 for any generic. Name brands are more based on aier system. Tier 1 is $24. Not sure about higher tiers. Some are free (birth control, for example).

Also have vision, dental, and a medical FSA.
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Old 21st August 2019, 09:19 PM   #53
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Originally Posted by Loss Leader View Post

With most insurances, Between $20 and $50 for the medical visit and $20 a month for the medications.
...after paying the $1,400+ deductible.
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Old 21st August 2019, 09:20 PM   #54
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Originally Posted by TomB View Post
I'd have to check a pay stub to be sure. I get the insurance through work. I have the family plan (Employee + 2 or more dependents) and I think my premium is around $250/month. Not sure about employer portion. I think my employer pays the whole thing.

I have pretty good insurance. I'm told it's better than the plan the insurance company employees get. Obviously, this is not typical.

Basically, $20 copay for most visit, $30 for specialists. ER $250 copay, (convenient care is $20) and if hospitalized, $250 copay per admission. Prescriptions are $8 for any generic. Name brands are more based on aier system. Tier 1 is $24. Not sure about higher tiers. Some are free (birth control, for example).

Also have vision, dental, and a medical FSA.
No deductible?
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Old 21st August 2019, 10:37 PM   #55
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Originally Posted by kellyb View Post
No deductible?
Right. No deductible.
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Old 21st August 2019, 11:03 PM   #56
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Originally Posted by TomB View Post
Right. No deductible.
Wow. Awesome! Congratulations!
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Old 22nd August 2019, 02:50 AM   #57
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Originally Posted by kellyb View Post
That makes sense, for a 15 minute visit. The government often owns the building the GP uses, right? And maybe even pays the utility bill?



I know the malpractice insurance docs in other countries pay is lower than in the US, too, because those costs are "socialized".



And then there isn't the army of billing experts to be paid like in the US, where docs have to fight tooth and nail for payment from the third party payers.
No. Nearly all GP practices are private companies, so pay for their own premises and so on.
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Old 22nd August 2019, 02:57 AM   #58
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Originally Posted by xjx388 View Post
Let's be real. The cost of providing basic physician services should be ridiculously low. The reason it isn't has mostly to do with the cost of education and government regulation and very little to do with physician greed.

The AMA's control of the supply of graduating doctors (to ensure supply shortage and high prices) doesn't make your radar then?
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Old 22nd August 2019, 06:08 AM   #59
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Originally Posted by Minoosh View Post
There are still premiums - $130 to $270 per month depending on income. And a roughly $1,000 deductible per hospitalization.
Indeed.

I was considering only the case described in the OP.

Yes, there are premiums.

One aspect I forgot: if youíre on Medicare, you can buy supplementary insurance, e.g. through AARP. Some plans cover all residual pharma costs (sorta). And thereís also a semi-private alternative, Medicare Advantage.

A curious fact about the cost of prescription drugs: end prices to patients can vary wildly! There are mail-order pharmacies, pharmacies ďinĒ with your insurance company, and even variations between two pharmacies within the same chain! It can truly pay to shop around, if you have the luxury of time.
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Old 22nd August 2019, 06:09 AM   #60
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Originally Posted by TragicMonkey View Post
Because that would be socialism! We didn't get together as a people to pool our resources and work together for our common good in programs administered by a popularly elected government in order to be socialists!
Yeah, thatís why we have Social Security
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Old 22nd August 2019, 06:13 AM   #61
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Originally Posted by JeanTate View Post
Yeah, thatís why we have Social Security
For the moment. I wouldn't bet on it being around when I'm eligible to claim it. At least, I don't think it'll be there for me to claim it. There have already been proposals to convert it to a system where everybody pays in but only certain people get paid out. I expect I'll pay in until death (and after) but never get a penny out of it.
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Old 22nd August 2019, 10:03 AM   #62
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Here is an interesting answer on Quora to a similar question
Quote:
I am retired, but my pension (on which I pay tax) is about the same as the national average wage. I’ve just got my tax information and last year the NHS cost me £744.

For that I’ve had two consultations with a neurologist, one with a gastroenterologist, one with an ophthalmologist and four with a general practitioner plus one gastroscopy. In the coming weeks I have more examinations by the ophthalmology department, another neurologist and an MRI. Plus all of my prescriptions are free.

I have no idea how much that would cost in the USA, or even if I could get insurance.
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Old 22nd August 2019, 10:06 AM   #63
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Originally Posted by welshdean View Post
Here is an interesting answer on Quora to a similar question
He would have insurance as a retired person: Medicare. Depending on income he might also qualify for reduced premiums and Medicaid. In the last case, his costs would be zero as Medicaid would pay his Medicare premiums and pick up Medicare deductibles and co-insurance. Hard to compare the two situations.
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Old 22nd August 2019, 10:18 AM   #64
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Originally Posted by xjx388 View Post
He would have insurance as a retired person: Medicare. Depending on income he might also qualify for reduced premiums and Medicaid. In the last case, his costs would be zero as Medicaid would pay his Medicare premiums and pick up Medicare deductibles and co-insurance. Hard to compare the two situations.
Medicaid isn't available to everyone, even if they are poor. Eligibility rules vary by state. In my state adults without dependents cannot get Medicaid, even if they have no income at all. The "safety net" is not there for all. I pay taxes for Medicaid but if I ever get too sick to work I will lose my health insurance and there will be no Medicaid help for me. My options then are to beg for charity or die. Gotta love capitalism!
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Old 22nd August 2019, 10:23 AM   #65
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Thatís true in Texas as well, until age 65 when there are programs for the elderly. Disabled adults also qualify. Your state has no programs for the elderly and disabled?

But I agree with you. Iíd like to see adults that fall under the poverty line get Medicaid as well.
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Old 22nd August 2019, 10:25 AM   #66
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Originally Posted by xjx388 View Post
He would have insurance as a retired person: Medicare. Depending on income he might also qualify for reduced premiums and Medicaid. In the last case, his costs would be zero as Medicaid would pay his Medicare premiums and pick up Medicare deductibles and co-insurance. Hard to compare the two situations.
As he points out, his pension is more or less the same as the average wage, so putting aside the fact that this particular person is a retired person, what would an employed person on the same pay have to fork out?

You can read the last sentence of his reply as:

"I have no idea how much that would cost in the USA, or even if I could get insurance, were I employed in the US on the same pay as my pension in the UK".
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Old 22nd August 2019, 10:28 AM   #67
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Originally Posted by jimbob View Post
Yes,

When I have time, I might dig out my posts that referenced papers looking at the administrative and advertising costs in US healthcare - it was well over 30%
Ah, it was my posts quoting blutoski:

Originally Posted by blutoski View Post
CMAJ had an [editorial with citations] and in 2002 a peer-reviewed research [article] showing profit motive significantly deducts from quality of care in healthcare, rather than enhancing it.

Canada and the US had identical systems until the end of a transition over 1969-1972, and in the time since then, the US has fallen drastically behind in outcomes and is now more than double the cost. This value gap has grown especially fast since 2000.

IIRC, HMOs' costs outside actual care delivery - eg: accounting, marketing/advertising, lobbying, lawsuits, claim screening, collections - has inflated to about 30% of costs, compared to between 1 and 2% in Canada, depending on province.

The efficiency of US healthcare delivery is considered to be less than half of Canada's, even though Medicare is almost as efficient. This means that outside of Medicare (which has a 2% overhead) - so that means HMOs and private hospitals - is less than half as efficient. Maybe about 35% as efficient, based on my back-of-the-envelope estimate.
From that link:

http://www.cmaj.ca/content/179/9/916.full#sec-2

Quote:
It is instructive to follow the health care dollar as it makes its way from employers to the doctors and nurses and hospitals that provide medical services. First, private insurers regularly skim off the top a substantial fraction of the premiums (about 15%Ė25%) for their administrative costs, marketing and profits.9 The remainder is passed along a veritable gauntlet of satellite businesses that have sprung up around the health care industry. These include brokers to cut deals, disease-management and utilization review companies, drug-management companies, legal services, marketing consultants, billing agencies and information management firms. They, too, siphon off some of the premiums, including enough for their administrative costs, marketing and profits. It was conservatively estimated that, in 1999, 31.0% of all health care spending in the US was for overhead, nearly twice the estimated 16.7% in Canada. The overhead for Canada's private insurers that year was 13.2%, compared with only 1.3% for its public system.10
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OECD healthcare spending
Expenditure on healthcare
http://www.oecd.org/els/health-systems/health-data.htm
link is 2015 data (2013 Data below):
UK 8.5% of GDP of which 83.3% is public expenditure - 7.1% of GDP is public spending
US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old 22nd August 2019, 10:35 AM   #68
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Originally Posted by 3point14 View Post
The AMA's control of the supply of graduating doctors (to ensure supply shortage and high prices) doesn't make your radar then?
It is one of the most anti-competetive aspects of our healthcare system.
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Old 22nd August 2019, 10:41 AM   #69
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Speaking of doctors, another problem in the US is that general practice is much less remunerative than specialization. When a regular old "gotta see the doctor" doctor (which everyone needs) makes five figures and a urologic oncologist makes two million it creates a bit of an overspecialization issue. Some areas are having a shortage of regular doctors and an overcrowding of specialists. The specialists don't fare that well out of it, either, since they're competing against each other and glutting the market. Only the lucky few land those big bucks after all.
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Old 22nd August 2019, 11:00 AM   #70
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Originally Posted by Dr. Keith View Post
It is one of the most anti-competetive aspects of our healthcare system.
And, as far as I can see, one of the least known or discussed.
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Old 22nd August 2019, 01:21 PM   #71
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The private insurance My wife and I have costs $A250 a month, and that’s not the highest cover as there is some capped out of pocket expenses after a private hospital stay. We are still prepared to pay this to avoid waiting lists.
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Old 22nd August 2019, 01:28 PM   #72
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Originally Posted by 3point14 View Post
And, as far as I can see, one of the least known or discussed.
I think it's largely a myth that the AMA artificially limits the number of doctors. A major factor is residency slots, which are funded mostly by Medicare and Medicaid. The number of positions funded is capped by law. Another factor is the number of med school slots. State Licensing schemes are another factor. The AMA does not have control over any of those things. In fact, the AMA is lobbying to lift the current cap.

You might argue that the AMA lobbies against increased roles for NPs and PAs -mid-level clinicians. But that argument is more about who should be able to practice medicine and how much training they should go through. If an NP or PA can do what a doctor does, then what is the point of med school? I think there's a legitimate argument there. Maybe we are too restrictive on who gets to practice medicine and maybe we should relax admission standards and licensing schemes -I'm open to arguments on that front.

But to say the AMA controls the number of doctors is overly simplistic.
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Old 22nd August 2019, 01:34 PM   #73
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Originally Posted by TragicMonkey View Post
Speaking of doctors, another problem in the US is that general practice is much less remunerative than specialization. When a regular old "gotta see the doctor" doctor (which everyone needs) makes five figures and a urologic oncologist makes two million it creates a bit of an overspecialization issue. Some areas are having a shortage of regular doctors and an overcrowding of specialists. The specialists don't fare that well out of it, either, since they're competing against each other and glutting the market. Only the lucky few land those big bucks after all.
The problem is that we've devalued primary care medicine. For example, NPs in most states can practice autonomously in primary care settings despite the fact that they've gone through less rigorous training than doctors. This drives down the price that insurers pay. It would be like letting paralegals practice law.
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Old 22nd August 2019, 01:44 PM   #74
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Originally Posted by xjx388 View Post
I think it's largely a myth that the AMA artificially limits the number of doctors. A major factor is residency slots, which are funded mostly by Medicare and Medicaid. The number of positions funded is capped by law. Another factor is the number of med school slots. State Licensing schemes are another factor. The AMA does not have control over any of those things. In fact, the AMA is lobbying to lift the current cap.
That is interesting. So, the AMA is not the bottleneck, but there is certainly a bottleneck?

Quote:
You might argue that the AMA lobbies against increased roles for NPs and PAs -mid-level clinicians. But that argument is more about who should be able to practice medicine and how much training they should go through. If an NP or PA can do what a doctor does, then what is the point of med school? I think there's a legitimate argument there. Maybe we are too restrictive on who gets to practice medicine and maybe we should relax admission standards and licensing schemes -I'm open to arguments on that front.
There is no limit on the number of people who can become lawyers in any state of the US. If you can pass the test you are qualified. OK, technically, you also have to go to law school, but there is an overabundance of law schools, so effectively there is no limit.

Pretty much the same for Professional Engineers. School, EIT test, work for a few years, PE exams. If you pass, you get to call yourself a PE, if you don't you aren't. No numerical limit, just standards.

I am so jealous of doctors.

Quote:
But to say the AMA controls the number of doctors is overly simplistic.
Thanks for helping to clear up some of these issues. It is appreciated when someone with practical experience chimes in.
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Old 22nd August 2019, 02:18 PM   #75
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Originally Posted by Dr. Keith View Post
That is interesting. So, the AMA is not the bottleneck, but there is certainly a bottleneck?
Yes, definitely a limit but I don't think you can pin it on any one entity.
Quote:
There is no limit on the number of people who can become lawyers in any state of the US. If you can pass the test you are qualified. OK, technically, you also have to go to law school, but there is an overabundance of law schools, so effectively there is no limit.
Don't forget the LSAT.
There are 201 law schools in the US with enrollment of 111,620. There are 179 med schools with enrollment of 91,391. So it's not like there's that many more law positions that make it virtually unlimited in comparison. Both professions are limited by the number of educational positions and the selectivity of the schools. It's not like just anyone can get into law school. Where they differ is in specialization. Lawyers, as I understand it, don't need to do a residency type of thing to get a specialization; just practice for awhile and pass a test. Residency is a further limiting factor in medicine. But I have to ask, would you want it any other way? Like your surgeon . . . shouldn't she have had some pretty rigorous, supervised and specialized training before she is allowed to slice you open?

Quote:
Pretty much the same for Professional Engineers. School, EIT test, work for a few years, PE exams. If you pass, you get to call yourself a PE, if you don't you aren't. No numerical limit, just standards.
I'm not sure how this is all that different from med school. The numerical limit is the number of positions in engineering programs. Not everyone can be an engineer. Again, the only difference is the residencies that docs have to go through.

Quote:
I am so jealous of doctors.
Don't be. There are so many restrictions on what doctors can do. Stark, Anti-Kickback, Physician Self-Referral, HIPAA, State Law, ad nauseam. They have to deal with government payers and insurers and are constantly under pressure with audits, legal threats, etc. I know other professions have their issues as well, but I think medicine is the most regulated industry down to the individual practitioner level. That's why physician burn out is a huge problem -and another contributor to the shortage.
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Old 22nd August 2019, 02:35 PM   #76
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Originally Posted by xjx388 View Post
Yes, definitely a limit but I don't think you can pin it on any one entity.
I think it all boils down to the number of residencies.

Is this saying that there are only 31,000 residencies every year? Maybe I'm reading that wrong.

Quote:
Like your surgeon . . . shouldn't she have had some pretty rigorous, supervised and specialized training before she is allowed to slice you open?
Yes, just like the engineer who signed off on the road you took to work this morning. But there is no hard limit on the number of engineers who can become qualified because the apprenticeship is more open. There is no hard cap.
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Old 22nd August 2019, 02:51 PM   #77
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Originally Posted by Minoosh View Post
Providers are scared they'll miss something and get sued. I had similar at her age with salmonella. In retrospect I needed IV fluids and with a few injections for pain, but by the time the results were in I'd had the whole radioactive milkshake/enema treatment.

With a lot of machines to pay off and a real fear of liability, plus I'm sure some degree of greed, $3,000 sounds ... about right. But it's very difficult to know upfront what the charges are going to be.
Yeah, I get that and that was part of the problem. I'm just going into the medical field myself but am knowledgeable enough to figure out what was going on and at first, I was agreeing with the doc. The doc did walk through it all with me and, given the tests and possible causes, yes, it was reasonable to want to test for appendicitis; the doc admitted there could be other causes but acting as if the most dire one was in my daughter's best interest. However, I didn't know enough to make a reasoned argument the next day, after my daughter was recovering. To my mind, something like appendicitis doesn't just "get better" over night; at least, once the pain (or abdominal discomfort) sets in, I don't think it would recede. My daughter's temp went down, the pain went away, she was a bit weak but feeling fine.

The other problem, however, is as I mentioned about the heavy pressure. In essence, the cruise ship doc was willing to pull rank and would not accept no for an answer. I don't recall signing anything quite like that when signing a contract for taking a cruise, after all. We were free to decline medical treatment but at the loss of the cruise as well as finding and paying for our own transportation back to our home.



Quote:
It can be kind of terrifying.
It was.


Originally Posted by xjx388 View Post
I don't agree that that is typical and standard in the US. You were on a cruise ship; those fees are going to be ridiculously high and it has nothing to do with the US system.

~$1800 for an ER visit with a CT sounds about right, but that cruise ship doc was extremely overpriced.
The cruise part is not typical. Use of the emergency department is, however. Even a basic urgent care clinic visit is $120ish just for walking in the door in my neck of the woods. Many people simply still cannot afford even this charge so end up going into an emergency department; the payment is never demanded up-front (as the clinics usually do) and sometimes hospitals will negotiate payment or even have a system in place to reduce the costs (including sometimes reducing the charge to zero and writing it off on the hospital's taxes or whatever).

And before anyone decides to make an issue of the fact that I and my daughter were on a cruise in the first place and can thus afford medical treatment, the tickets were a gift from family in a sense. She and I are paying the cost back but my parents and sister and I (along with my sisters' two daughters and my own) desired to go for a, perhaps last, family vacation.

The cost of medical treatment -- the $1,500 copay -- was again only paid as a personal loan which I'm paying back on behalf of my daughter. So even then, neither she nor I could possibly have afforded the cost of just the ED visit, never mind the additional cruise medical attention.

Again and again I guess I have to say that none of this -- not an absurdly high medical bill and not an absurdly high insurance deductible -- NONE OF THIS IS NECESSARY IN THE RICHEST ************* COUNTRY ON THE PLANET.



Originally Posted by TragicMonkey View Post
Because that would be socialism! We didn't get together as a people to pool our resources and work together for our common good in programs administered by a popularly elected government in order to be socialists!
The sad truth is that the ONLY time in the history of the country that we got a 40-hour work week, medicaid, retirement benefits at all is because of the American socialist party, the American communist party, very strong unions, and other related groups were powerful enough to seriously threaten the status quo, fought for and won these things that have been steadily eroded.

Now we, as a society, are reduced to begging for scraps amongst the disgusting splendor of the rich.
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Old 22nd August 2019, 04:32 PM   #78
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Originally Posted by Pope130 View Post
You may have trouble finding a comparison to Americans without any health insurance. Given that the great majority have insurance, I suspect there may be few to none on the forum.

My most recent medical adventure was the result of an accident (fell out of tree) five ribs broken in eight places, punctured lung, tension pneumothorax, cracked vertebra, broken scapula. That resulted in an ambulance ride, a two week hospital stay with X-rays and NMRI, chest tube, drugs, etcetera.

I'm retired, covered by insurance from a former employer. $0.
I am uninsured.
My doctor will see me for $80.
I take a blood pressure med that cost $19 per month (generic). And he can write prescriptions for colds and flu and the like.
All very affordable.

His suggestions regarding the more advanced tests that he would like to see (colonoscopies and such) I must decline.
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Old 25th August 2019, 09:09 AM   #79
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Originally Posted by TomB View Post
With my insurance, total cost would have been $36.

$20 for the appointment (HMO copay. No deductible.)
$8 for each prescription, assuming you get generics.
When I had good insurance that was about what I would pay for something like that.

On top of $300 every month for the privilege of access.

So, if I had done that in the US with pretty good insurance it would cost $3628.

I think I would rather pay a few hundred more in taxes.
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Old 25th August 2019, 09:20 AM   #80
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Originally Posted by welshdean View Post
I just can't get my head around the fact that you yanks won't do UHC.
In simple terms, we British pay around 11% of our gross salary and that covers us for all social welfare needs. Lost your job, here's your dole money. In a coma, your hospital bill is covered. Why do you not see the benefit of that kind of system? There is no downside.
It all comes down to the wealthier people feeling entitled to special treatment. If the workers are getting the same decent care the wealthy get then there is no way to gloat about how much better the rich are.

The US doesnít have an official aristocracy, so they need to invent an ersatz one.
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