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[Medicine In The US]: An American Cluster*@#%

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Posts

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2011
    Mace1370 wrote: »
    I'm saying do both. I guess agree to disagree?

    Tort reform kind of fucks over people who really were harmed by medical errors, though.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • AngelHedgieAngelHedgie Registered User regular
    edited May 2011
    Mace1370 wrote: »
    big l wrote: »
    Mace1370 wrote: »
    big l wrote: »
    Mace1370 wrote: »
    I will say this about defensive medicine, though. It happens. You may say that it's BS, but I've seen it countless times and I've been told stories about it countless times. I don't think it is the biggest factor, but it absolutely plays a role and to discount it entirely is foolish.

    "Hey there Dr. Doctor! I noticed you prescribed this unnecessary treatment. Why did you prescribe it?"

    Doctor has two possible responses:
    "I prescribed it because I got paid to do it and I like money."
    "I prescribed it because I wanted to do defensive medicine and cover my bases."

    Which do you think they're going to say? I'm not saying they're lying - I'm sure in many cases, they believe that they are doing it totally for the right reason, for the benefit of the patient, etc. But the profit motive is powerful and insidious, and can be an underlying cognitive bias without one noticing it. If there isn't a financial incentive to do defensive medicine (as is the case in examples given in the linked Gawande article), defensive medicine is practiced much less.

    I agree that the motive for profit is going to play a much bigger role than that of defensive medicine. There are, however, absolutely instances where a doctor orders a test that he personally doesn't think is necessary but does so to cover his bases. I feel like we are talking in circles.

    It's a case of "what is the correct policy solution?" If doctors are over-prescribing because they are actually under threat of lawsuit and they really really do need to cover their bases, then we need tort reform. If they are over-prescribing because they get paid more to do it, we need to change physician compensation schemes from fee-for-service to bundled payments and have the IMAP board get Medicare to stop paying for the unnecessary treatments. My argument is that the second case is in fact true, and that when we craft our policy response we should ignore the defensive medicine excuse, because it's wrong, and not do tort reform.

    I'm saying do both. I guess agree to disagree?

    Except that there is no evidence that there is a problem with frivolous malpractice lawsuits in the US. So "tort reform" is not necessary.

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  • RobmanRobman Registered User regular
    edited May 2011
    Tort reform is horrendous bullshit that is a wonderful wedge-issue to draw attention away from real questions about healthcare. Like, why are Americans content to allow 30%+ overheads on their healthcare funds, rather then 1-2% like any decent government-run single payer system?

    Even if the prices for services remained the same, you'd increase the actual amount of money going towards paying for patient services by 50%

  • Mace1370Mace1370 Registered User regular
    edited May 2011
    Mace1370 wrote: »
    big l wrote: »
    Mace1370 wrote: »
    big l wrote: »
    Mace1370 wrote: »
    I will say this about defensive medicine, though. It happens. You may say that it's BS, but I've seen it countless times and I've been told stories about it countless times. I don't think it is the biggest factor, but it absolutely plays a role and to discount it entirely is foolish.

    "Hey there Dr. Doctor! I noticed you prescribed this unnecessary treatment. Why did you prescribe it?"

    Doctor has two possible responses:
    "I prescribed it because I got paid to do it and I like money."
    "I prescribed it because I wanted to do defensive medicine and cover my bases."

    Which do you think they're going to say? I'm not saying they're lying - I'm sure in many cases, they believe that they are doing it totally for the right reason, for the benefit of the patient, etc. But the profit motive is powerful and insidious, and can be an underlying cognitive bias without one noticing it. If there isn't a financial incentive to do defensive medicine (as is the case in examples given in the linked Gawande article), defensive medicine is practiced much less.

    I agree that the motive for profit is going to play a much bigger role than that of defensive medicine. There are, however, absolutely instances where a doctor orders a test that he personally doesn't think is necessary but does so to cover his bases. I feel like we are talking in circles.

    It's a case of "what is the correct policy solution?" If doctors are over-prescribing because they are actually under threat of lawsuit and they really really do need to cover their bases, then we need tort reform. If they are over-prescribing because they get paid more to do it, we need to change physician compensation schemes from fee-for-service to bundled payments and have the IMAP board get Medicare to stop paying for the unnecessary treatments. My argument is that the second case is in fact true, and that when we craft our policy response we should ignore the defensive medicine excuse, because it's wrong, and not do tort reform.

    I'm saying do both. I guess agree to disagree?

    Except that there is no evidence that there is a problem with frivolous malpractice lawsuits in the US. So "tort reform" is not necessary.

    Just so I understand you, are you saying that not enough frivolous malpractice lawsuits happen for it to financially matter? If not, could you clarify your usage of "problem"?

  • TheOtherHorsemanTheOtherHorseman Registered User regular
    edited May 2011
    Except that when pressed, doctors themselves admit that "defensive medicine" is BS

    A few doctors in a specific place said that, yes.

    However, defensive medicine is real. That being said, it has a relatively minor impact on overall health care costs. While any reforms that aim to reduce defensive medicine would be nice, it is probably one of the last places we need to look if we want to reduce costs in the USA.

  • rndmherorndmhero Registered User regular
    edited May 2011
    Mace1370 wrote: »
    Just so I understand you, are you saying that not enough frivolous malpractice lawsuits happen for it to financially matter? If not, could you clarify your usage of "problem"?

    He's not saying it; the CBO is.
    The CBO wrote:
    The report concluded that caps on damage awards consistently reduced the size of claims and, in turn, premium rates for malpractice insurance. Further, it found that limiting the use of joint-and-several liability, requiring awards to be offset by the value of collateral-source benefits, and reducing statutes of limitations for filing claims were also effective in slowing the growth of premiums.

    ...

    Savings of that magnitude would not have a significant impact on total health care costs, however. Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small.

    TL;DR: Malpractice costs are increasing and there are measures that can be taken to decrease those expenditures, but they aren't a significant contributor to health care prices overall.

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  • AngelHedgieAngelHedgie Registered User regular
    edited May 2011
    Except that when pressed, doctors themselves admit that "defensive medicine" is BS

    A few doctors in a specific place said that, yes.

    However, defensive medicine is real. That being said, it has a relatively minor impact on overall health care costs. While any reforms that aim to reduce defensive medicine would be nice, it is probably one of the last places we need to look if we want to reduce costs in the USA.

    Again, "defensive medicine" is gooseshit because its underlying bases are false. It doesn't withstand scrutiny.

    And yes, Mace, that is exactly what I am saying, because it is really fucking hard to get a frivolous lawsuit going. Things like contingency fee and summary dismissal act as checks against them, especially when the suing party doesn't have money.

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  • TheOtherHorsemanTheOtherHorseman Registered User regular
    edited May 2011
    Except that when pressed, doctors themselves admit that "defensive medicine" is BS

    A few doctors in a specific place said that, yes.

    However, defensive medicine is real. That being said, it has a relatively minor impact on overall health care costs. While any reforms that aim to reduce defensive medicine would be nice, it is probably one of the last places we need to look if we want to reduce costs in the USA.

    Again, "defensive medicine" is gooseshit because its underlying bases are false. It doesn't withstand scrutiny

    What underlying bases do you think are false on a national scale, given that your article addressed one idiosyncratic place?

  • Hahnsoo1Hahnsoo1 Registered User regular
    edited May 2011
    "Defensive medicine" doesn't have to be rational for doctors to practice it. It also varies among subspecialty. ER Physicians and Obstetricians are far more likely to do order tests in the name of defensive medicine (i.e. Cover Your Ass), although the typical ER visit isn't likely to trigger this, just like the typical birth isn't likely to trigger this. When things are in a rush, when it's close to changeover and you know that you want to tuck your patients in for the next team, when an important case needs to head up to the ICU, you are going to be darn sure that the next team that gets the patient is going to be prepared with the admitting information. Every resident I know is told by their seniors and peers to CYA. Except for possibly Dermatology. It's a thing, whether the studies and projections say it has an impact or otherwise.

    It's not just about being sued. Doctors, believe it or not, actually care whether or not their patients are going to die. They want their patients to get better. Defensive medicine is about "Hey, I should do this thing, just in case, because I don't want to miss something." Even if it isn't cost-effective, that nagging feeling of "I missed something" will spur another test.

    Personally, I think that the US should front the cost of preventative medicine wholesale. Allow people to get in their checkups on the government's dime. Ration the yearly/bi-yearly/tri-yearly or "whatever the hell interval is cost effective" checkup. Let people know that they are safe to go to the doctor and figure out what's going on. Private insurance can cover the rest.

    That should reduce the overall costs of healthcare across the board. If it doesn't, we are totally fucked, because that means that the system we have now is the best it's ever going to get, and it's only getting worse in the future. This is the current proposal.

    EDIT: I suppose we could always go to the system they have in some other countries, where if you don't pay up front, you don't get treated in most hospitals. I'm sure that would go over well.

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  • AngelHedgieAngelHedgie Registered User regular
    edited May 2011
    Except that when pressed, doctors themselves admit that "defensive medicine" is BS

    A few doctors in a specific place said that, yes.

    However, defensive medicine is real. That being said, it has a relatively minor impact on overall health care costs. While any reforms that aim to reduce defensive medicine would be nice, it is probably one of the last places we need to look if we want to reduce costs in the USA.

    Again, "defensive medicine" is gooseshit because its underlying bases are false. It doesn't withstand scrutiny

    What underlying bases do you think are false on a national scale, given that your article addressed one idiosyncratic place?

    The underlying core of "defensive medicine" is to CYA oneself legally. The arguments used to justify this are that it's really easy to get sued, even over a frivolous matter; that because of the first point, malpractice insurance rates are rising; and that the doctor is at a disadvantage in the courtroom. These don't hold true.

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  • Hahnsoo1Hahnsoo1 Registered User regular
    edited May 2011
    Even if the so-called "underlying arguments" don't hold true, and you can call every single doctor in the US out there and tell them this, the doctors will still practice Defensive Medicine for the Cover Your Ass principle. They are told as residents to do this and are chewed out by their superiors if they don't. Of course, residents are also chewed out for doing frivolous tests and searching for zebras instead of horses, but they are far more likely to get reamed a new one by an attending for not doing a test. Unfortunately, it's engrained in the doctors' education and their culture, and doctors are just as much creatures of habit as normal humans.

    Yeah, "we've always done it that way" isn't a great excuse either. But it doesn't have to be rational to be the status quo. The vast majority of Americans expect to get X-rays done even if a doctor can properly diagnose an injury without one. It's like "if it wasn't X-rayed, it didn't happen" or something, even though a properly annotated chart is proper care in that situation.

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  • TheOtherHorsemanTheOtherHorseman Registered User regular
    edited May 2011
    Except that when pressed, doctors themselves admit that "defensive medicine" is BS

    A few doctors in a specific place said that, yes.

    However, defensive medicine is real. That being said, it has a relatively minor impact on overall health care costs. While any reforms that aim to reduce defensive medicine would be nice, it is probably one of the last places we need to look if we want to reduce costs in the USA.

    Again, "defensive medicine" is gooseshit because its underlying bases are false. It doesn't withstand scrutiny

    What underlying bases do you think are false on a national scale, given that your article addressed one idiosyncratic place?

    The underlying core of "defensive medicine" is to CYA oneself legally. The arguments used to justify this are that it's really easy to get sued, even over a frivolous matter; that because of the first point, malpractice insurance rates are rising; and that the doctor is at a disadvantage in the courtroom. These don't hold true.

    While a perception of a need to CYA would function just as well as an actual need for the purposes of engaging in defensive medicine, it's also worth noting that whether or not the doctor is at a disadvantage doesn't matter if the doc just doesn't find a lawsuit to be worth a few extra tests. Hansoo also points out a different sort of defensive medicine - throwing a bunch of not-quite-unfounded but not-definitely-needed tests at a patient in order to cover the patient's ass as well.

  • rndmherorndmhero Registered User regular
    edited May 2011
    Either way, whether or not we shave off that 0.5% of health care costs isn't really going to significantly alter the future of the American health care system.

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  • TheOtherHorsemanTheOtherHorseman Registered User regular
    edited May 2011
    rndmhero wrote: »
    Either way, whether or not we shave off that 0.5% of health care costs isn't really going to significantly alter the future of the American health care system.

    Pretty much. The real money is to be saved is in getting people to primary care docs, working to reduce the number of people that see ER docs as primary care docs, and reducing future rates of the huge money-draining diseases - Diabetes, lung disease, heart disease. All pretty preventable, and all a burden on patient and health-care system. Also conditions that predispose folks to wildly expensive end-of-life care that probably outweighs the entirety of what they spent on health-care over the rest of their life by quite a bit.

    Some steps have been taken, but we need ready coverage of regular checkups in insurance plans, perhaps monetary incentives to keep more in your pocket if you get those check-ups, and incentives on reimbursement/doctor-side. Medicaid is a hot mess. There are doctors in private practice who have to carefully manage the number of Medicaid patients they take, if they accept Medicaid, simply because they lose money if the patient needs treatment due to poor reimbursement rates.

  • UseskaforevilUseskaforevil Registered User
    edited May 2011
    $60 for an office visit could easily be a loss after you factor in the loss of revenue for 4-5 extra years of schooling (where you're not making $ either, which puts you about 40k in the whole each year), up to $300,000 to $500,000 in student loan debt, over head for all of the office, staff, and malpractice insurance which can be hundreds of thousands a year depending on specialty. plus if i'm just going to be making under 100k a year, i'd go into something else. there is way too much time and risk involved to do this for less.

    Doctors do not simply use drugs because a pharm rep told them to or bought them a dinner. don't be a goose, we go to school for a reason. there was a study that showed that the more a pharm rep from brand A spent time with doctors the more likely they were to prescribe brand A over another, but only if it was an appropriate treatment anyway. drug reps are actually pretty essential as often their meetings and appointments help to educate about new drugs and procedures doctors don't have time to research 100% on their own. my mom actually just had a dinner with a surgeon that a drug rep set up to learn how they use the drug in their practice, and of course why she should consider it.

    juries are not always biased against doctors, but good luck trying to counter sue against frivolous lawsuits. my mother has had personal experience with that.

    malpractice insurance is a significant factor at least in OH. we have had doctors leave because of this.

    and just for the record I hate the current situation, i'm fighting with my insurance right now because my doc wanted to do a t3/t4 test after a red flag at a physical and they don't want to pay it since its not part of a routine physical (never mind i'm covered for 90% labs that aren't part of physicals) and owing another $750 doesn't make studying easy.

  • NeadenNeaden Registered User regular
    edited May 2011
    Is this a good thread to talk about how Doctors often times use lobbying tactics and lies to try to prevent themselves from being undercut by PAs and Nurse Practioners despite no studies saying there is a difference in care for most things? Stuff like this shit which show that doctors associations are willing to sacrifice patient care and costs so they can make more money?

  • UseskaforevilUseskaforevil Registered User
    edited May 2011
    oh yea i totally agree that nurses that aren't trained to do diagnosis of symptoms should get to treat those symptoms without any supervision. and anyone that disagrees is only in it for the money. with a average salary of just $189k as opposed to $211k think of all the savings. what lies?

    also "The figures have not been adjusted for the different diagnosis-related group surgical cases that are typical of the two types of anesthesia providers. With the exception of base units, the differences in patient characteristics between the certified registered nurse anesthetist solo and anesthesiologist solo groups, although statistically significant, were clinically minor and would not explain large differences in patient outcomes within opt-out and non-opt-out states"

    why did they not include it if it was statistically significant? just trying to prove a point and not happy with the data?

  • TheOtherHorsemanTheOtherHorseman Registered User regular
    edited May 2011
    Neaden wrote: »
    Is this a good thread to talk about how Doctors often times use lobbying tactics and lies to try to prevent themselves from being undercut by PAs and Nurse Practioners despite no studies saying there is a difference in care for most things? Stuff like this shit which show that doctors associations are willing to sacrifice patient care and costs so they can make more money?

    On my side of the battle lines, there's the talk is more about how nurses are lobbying to gain more independence with self-funded studies with flawed methodology, and concern about the manufacturing of advanced degrees that consist largely of online coursework and provide less actual education than medical school itself, let alone residency. Not to mention arguments made like, "it will improve rural care," even though nurses and PA's are subject to the same human biases that doctors are when it comes to, by and large, wanting to live in suburban and urban areas.

    Nursing organizations are very good at messaging, and that's to their credit and the benefit of their members, but there are other sides of the issue.

  • Fuzzy Cumulonimbus CloudFuzzy Cumulonimbus Cloud Registered User regular
    edited May 2011
    This is a big storm in university clinics. They try their hardest to remain as cheap as possible to students, but it is damn near impossible to subsidize care enough that the student doesn't have to pay anymore. Also, all the insurance companies are pushing for the student clinics to start taking insurance cards. It is a racket.

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  • Hahnsoo1Hahnsoo1 Registered User regular
    edited May 2011
    In regards to that Slate column, in my experience, Anesthesiologists don't go around adjusting everyone's pain medication on the floor. I've only known one who did that, and he was asked to consult by the physicians who primarily care for those patients. Anesthesiologists aren't generally consulted for the routine tasks like injections. I'm not sure what the person is arguing other than "I don't like this law; therefore, it's part of a doctor conspiracy, obviously" while stating a bunch of accurate but ultimately tangential facts. Apples and oranges indeed.

    And any editorial column that writes "Obamacare" in its missive would normally get a pass from me. *shrugs* (EDIT: As in, I wouldn't read the rest of it, normally. I think Obamacare is a stupid and inflammatory term. Any professional should be ashamed of using it)

    EDIT 2: Do anesthesiologists run around adjusting pain meds on the floor now everywhere? Is this a "new thing"? Any of you folks who work in hospitals, even as a student, can verify this?

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  • NeadenNeaden Registered User regular
    edited May 2011
    oh yea i totally agree that nurses that aren't trained to do diagnosis of symptoms should get to treat those symptoms without any supervision. and anyone that disagrees is only in it for the money. with a average salary of just $189k as opposed to $211k think of all the savings. what lies?

    also "The figures have not been adjusted for the different diagnosis-related group surgical cases that are typical of the two types of anesthesia providers. With the exception of base units, the differences in patient characteristics between the certified registered nurse anesthetist solo and anesthesiologist solo groups, although statistically significant, were clinically minor and would not explain large differences in patient outcomes within opt-out and non-opt-out states"

    why did they not include it if it was statistically significant? just trying to prove a point and not happy with the data?
    Thanks for missing the point. The main issue isn't cost, it is availability. Anesthesiologists are in short supply especially in rural areas. This is true of medical specialists in general. [url=
    http://www.healthleadersmedia.com/content/COM-246358/Nurse-Anesthetists-Battle-Overlooks-Rural-Doctor-Shortage]Here is an article on the issue[/url]. Secondly that is saying that the two patient groups had some statistically significant differences, but they are of things that shouldn't effect outcomes. To use a hypothetical example, maybe one group had more blonds, but that shouldn't matter. You don't need to adjust for everything to have a valid study.

    Theotherhorseman, do you have any cites about problems with this study? Do you have any evidence that nurse anesthetists in this setting don't do as good a job as anesthesiologists. No one is advocating replacing anesthesiologists completely after all. I'm not a nurse or anything and don't have any family who are nurse anesthetists, hell, I don't think I've ever even met a nurse anesthetist so it is not like this is my side. But all the studies I have seen indicate that they do fine and all the stuff I haven't seen a good argument from opponents that has any studies backing it up.

    Edit: Here's the study on it I can't access it where I am right now.
    Edit 2: Oh and hey, theres a physician response to it underneath where the guy mentions one case where a nurse anesthetist screws up because a single anecdote means anything at all.

  • TheOtherHorsemanTheOtherHorseman Registered User regular
    edited May 2011
    It looks like the immediate study referenced was actually some sort of analysis of a number of primary research papers, so I can't speak to whether or not the methodology is sound for each paper. I was also not directly trying to critique the methodology, but point out the opposing view given how incendiary and convinced you seemed in your original post.

    And I'm gonna give that doc a pass, given the anecdote in the article he was commenting on. Neither story really means jack squat in the grand scheme.

  • rndmherorndmhero Registered User regular
    edited May 2011
    Both sides of this discussion have valid points because this isn't as simple as doctors vs. nurses. There are a plethora of facilities and circumstances through which medical care is provided, each of which has different requirements. There is so much variance, however, that it's difficult to tell what is genuine concern for patient care and what is good old-fashioned turf wars.

    There were quite a few feathers roughened in the anesthesiologist community as CRNAs began gaining prominence. Some thought it would mean the end of the profession, while others thought it would mean a wave of patient deaths. Neither happened, and in most places the two have found common ground. The infighting you still see (like the article posted above) is mostly petty, territorial stuff, and it absolutely comes from both organizations involved.

    The more serious questions being raised are regarding mid-level providers (nurse practitioners and physicians assistants) in primary care. There's a substantial push to see more of them handling primary-care duties, but it's receiving considerable resistance from the physician community. It will be interesting to see how that plays out.
    Hahnsoo1 wrote: »
    EDIT 2: Do anesthesiologists run around adjusting pain meds on the floor now everywhere? Is this a "new thing"? Any of you folks who work in hospitals, even as a student, can verify this?

    No, it's certainly not common practice. Pain is generally handled by the attending team, and more intractable cases bring in a palliative care consult. I've only seen anesthesiologists get involved for one-shot procedural things (ganglion blocks and whatnot).

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  • Hahnsoo1Hahnsoo1 Registered User regular
    edited May 2011
    The study was written by two health economists (which blows my mind... how do you get this job? Seems pretty hyperspecialized to me) based on 1999-2005 Medicare reimbursements. The reason that start date is chosen is because 2001 is the first year that Medicare allowed states to opt out of oversight requirements for nurse anesthetists. I'm not sure it's entirely relevant to the opinion article's point. The types of procedures that you have anesthesiologists and nurse anesthetists do aren't really in the realm of "managing the patients on the floor". That typically falls to the regular less-trained nurses and regular non-specialized doctors.

    To put it another way, he posits a solution to pain med distribution to the average hospital patient is to "let trained nurses do it!" But this assumes that nurse anesthetists undergo their training so that they can run around giving pain meds to patients. They CAN do this (historically, Anesthesia was the realm of Nursing. In 1942, there were 17 nurse anesthetists to 1 anesthesiologist). But I think most of them get into the field to intubate patients, manage their OR anesthesia, and assist in emergence and recovery. I could be wrong, however.

    I think some things get lost in the legalese, too. The whole "practice of medicine" language is a bit weird, since you can delivery anesthesia or pain meds as a dentist through the "practice of dentistry", and even as a nurse through the "practice of nursing". Each of them are separately defined by law, as to avoid overlap of rulings (although dentistry, medicine, and nursing have had legal precedents overlap with each other).

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  • UseskaforevilUseskaforevil Registered User
    edited May 2011
    well the article certainly cared about the cost, whether you did or not. also just to increase patient access i don't believe we should lower standards.

    the difference was not in hair color though was it? if the study itself admitted to it being clinically minor why not publish what the difference was rather than hand waving it away. Then i couldn't argue this way could I?

    "The study was financed by the American Association of Nurse Anesthetists" strange that it was so favorable.

  • LaliluleloLalilulelo Richmond, VARegistered User regular
    edited May 2011
    I saw an old news clip about pharmacies charging up the ass for medications (300-400) dollars for generic brand cancer medicine, while a store like costco charges 27 dollars for it. Costco never sells below cost; at-cost if they're being generous, but there's always at least a small mark up. Why the hell is the retail cost everwhere else marked up 2,000% ? When questioned their responses were basically, 'because we can,' and 'most of the cost is deferred to their insurance providers anyway.' Which MAKES HEALTHCARE EXPENSIVE, YOU FUCKS.

  • rndmherorndmhero Registered User regular
    edited May 2011
    Again from Krugman's analysis in his book, we could shave 10% off our health care costs (or 20 times that of malpractice reform, for those keeping score) by allowing Medicare to barter prescription drug prices, something almost every other country on earth does.

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  • UseskaforevilUseskaforevil Registered User
    edited May 2011
    Lalilulelo wrote: »
    I saw an old news clip about pharmacies charging up the ass for medications (300-400) dollars for generic brand cancer medicine, while a store like costco charges 27 dollars for it. Costco never sells below cost; at-cost if they're being generous, but there's always at least a small mark up. Why the hell is the retail cost everwhere else marked up 2,000% ? When questioned their responses were basically, 'because we can,' and 'most of the cost is deferred to their insurance providers anyway.' Which MAKES HEALTHCARE EXPENSIVE, YOU FUCKS.

    cite please.

  • Hahnsoo1Hahnsoo1 Registered User regular
    edited May 2011
    I'd be interested in what "cancer medicine" that news story was talking about. I mean, if it's sold at Costco, then it's some sort of over-the-counter drug, and not something like monoclonal antibody derivatives or other esoteric expensive stuff (which are genuinely pretty expensive).

    If someone is going through cancer treatment, though, that's a very very small drop in a very very large cost bucket. I can see how laundering higher costs for OTC drugs by folding it into cancer treatment reimbursements would be a wonderful scam.

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  • LaliluleloLalilulelo Richmond, VARegistered User regular
    edited May 2011
    Costco warehouses have pharmacies.

    also, I can't post a citation because it was a news clip from a couple years ago that I watched during a company meeting. It was a story on some local news channel (not sure which one).

  • UseskaforevilUseskaforevil Registered User
    edited May 2011
    i did find a forum that stated that Tamoxifen at costco was about 1/3rd the price of CVS if you got the 90day dose rather than 3 30s. which is great, but not what you're stating. also giant eagle (a store around here) doesn't even charge for antibiotics as a ploy to get you to use their pharmacy for everything and I'm sure, shop at their grocery store. does that mean everyone who charges for antibiotics is a crook?

  • UseskaforevilUseskaforevil Registered User
    edited May 2011
    Lalilulelo wrote: »
    Costco warehouses have pharmacies.

    also, I can't post a citation because it was a news clip from a couple years ago that I watched during a company meeting. It was a story on some local news channel (not sure which one).

    well then excuse me if I just keep on not believing it then.

  • shrykeshryke Member of the Beast Registered User regular
    edited May 2011
    Robman wrote: »
    Tort reform is horrendous bullshit that is a wonderful wedge-issue to draw attention away from real questions about healthcare. Like, why are Americans content to allow 30%+ overheads on their healthcare funds, rather then 1-2% like any decent government-run single payer system?

    Even if the prices for services remained the same, you'd increase the actual amount of money going towards paying for patient services by 50%

    The problem is trying to treat health care like it's a consumer market of some sort.

    Krugman had a good rant on this a week or so back, saying the obvious: Patients Are Not Consumers
    Spoiler:

    But the more you treat medical care like a business transaction, the more fucked up everything gets.

    And the worst part is, patients aren't even consumers on a basic level. The patient doesn't pay for their care, their insurance company does. If anyone is a consumer here, it's your insurance company. The patient is largely just the clueless middle-man/rube who gets caught in the fight between competing interests all out for maximum profit.

    This American Life actually had a good program on one of the cases of this a few years back, about how co-pays and coupons for drugs are nothing more then volleys in a huge battle between your insurance and pharma companies over profits and how the consumer gets fucked by the whole thing.

    Basically:
    Spoiler:

  • Chaos PunkChaos Punk Registered User
    edited May 2011
    All other state's should follow Maryland's Johns Hopkins Private University and Medicine Systems.

    http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/jhhhs.html

    We are all the man behind the curtain.... pay no attention to any of us
  • Hahnsoo1Hahnsoo1 Registered User regular
    edited May 2011
    Other than being a shining public image for Johns Hopkins, what else is that link supposed to be? I mean, why in your estimation should everyone be like Johns Hopkins? Looks more like an advertisement rather than any talking points there.

    They can't all be teaching hospitals, after all. There are far more hospitals than incoming students and graduates.

    Steam ID: Hahnsoo, Steam Name currently: Hahnsopolis | PSN: Hahnsoo | Monster Hunter Tri: Hahnsoo, E8HJCA
  • Chaos PunkChaos Punk Registered User
    edited May 2011
    adytum wrote: »
    I read that article back when it was published. It's awful, in a "weep for my country" way. Physicians at physician-owned for-profit hospitals tend to ask for more tests? Surprise! Incentives!

    The biggest takeaway is how utterly corrosive profit is in healthcare. The final third of the article is the most frightening, frankly.

    AngelHedgie,

    I appreciate your starting this thread, because all jokes and snark aside, medical issues are extremely important to me and to most Americans. There is something terribly wrong with the healthcare system in America, both in the government and in private insurance. What was it 75-80% of the bankruptcies in the past 10 years where people had over $5,000 worth of medical debt? It's disturbing indeed. I'm as self-reliant as any, and I have inflexible work ethics, but the prospect of incurring a 50k medical bill is quite daunting, and turns even the strongest of us into whiny little bitches.

    Our country needs to address this issue without the slander or partisanship, maybe even perhaps with a little compromise. I think your points of view are probably well-intentioned, but I think you may be somewhat emotionally invested in the debacle of the profit-drive in healthcare, which is a bit confusing to me. The moral end of health improvement in general (IE. wanting people to live longer, healthier lives) is noble, but your reasoning is neglecting economics...

    I read this article in National Affairs (I don't know if anybody has posted it yet or not), but I think it's pretty balanced for the most part, and demonstrates with good evidence why healthcare reform needs morals and economics (profit-motive):

    http://www.nationalaffairs.com/publications/detail/health-care-and-the-profit-motive

    We are all the man behind the curtain.... pay no attention to any of us
  • Pi-r8Pi-r8 Registered User regular
    edited May 2011
    Chaos Punk wrote: »
    adytum wrote: »
    I read that article back when it was published. It's awful, in a "weep for my country" way. Physicians at physician-owned for-profit hospitals tend to ask for more tests? Surprise! Incentives!

    The biggest takeaway is how utterly corrosive profit is in healthcare. The final third of the article is the most frightening, frankly.

    AngelHedgie,

    I appreciate your starting this thread, because all jokes and snark aside, medical issues are extremely important to me and to most Americans. There is something terribly wrong with the healthcare system in America, both in the government and in private insurance. What was it 75-80% of the bankruptcies in the past 10 years where people had over $5,000 worth of medical debt? It's disturbing indeed. I'm as self-reliant as any, and I have inflexible work ethics, but the prospect of incurring a 50k medical bill is quite daunting, and turns even the strongest of us into whiny little bitches.

    Our country needs to address this issue without the slander or partisanship, maybe even perhaps with a little compromise. I think your points of view are probably well-intentioned, but I think you may be somewhat emotionally invested in the debacle of the profit-drive in healthcare, which is a bit confusing to me. The moral end of health improvement in general (IE. wanting people to live longer, healthier lives) is noble, but your reasoning is neglecting economics...

    I read this article in National Affairs (I don't know if anybody has posted it yet or not), but I think it's pretty balanced for the most part, and demonstrates with good evidence why healthcare reform needs morals and economics (profit-motive):

    http://www.nationalaffairs.com/publications/detail/health-care-and-the-profit-motive

    I give that article some credit for at least acknowledging that our health care system is screwed up, and trying to examine the arguments of both sides. But... I really don't agree with anything it says.

    In particular, it argues that the profit motive encourages insurance companies to keep costs down. What it really does though, is encourage them to find any kind of loophole to avoid paying for expensive treatments, even after someone has been paying insurance premiums for years.

    And the idea of a "health savings account" is ridiculous, and completely defeats the purpose of insurance. Insurance isn't to protect you against the mild, likely problems- it's to protect against the really severe and unlikely ones. A normal person can't possible save up enough money to pay for a serious health problem.

  • rockrngerrockrnger Registered User regular
    edited May 2011
    Chaos Punk wrote: »
    adytum wrote: »
    I read that article back when it was published. It's awful, in a "weep for my country" way. Physicians at physician-owned for-profit hospitals tend to ask for more tests? Surprise! Incentives!

    The biggest takeaway is how utterly corrosive profit is in healthcare. The final third of the article is the most frightening, frankly.

    AngelHedgie,

    I appreciate your starting this thread, because all jokes and snark aside, medical issues are extremely important to me and to most Americans. There is something terribly wrong with the healthcare system in America, both in the government and in private insurance. What was it 75-80% of the bankruptcies in the past 10 years where people had over $5,000 worth of medical debt? It's disturbing indeed. I'm as self-reliant as any, and I have inflexible work ethics, but the prospect of incurring a 50k medical bill is quite daunting, and turns even the strongest of us into whiny little bitches.

    Our country needs to address this issue without the slander or partisanship, maybe even perhaps with a little compromise. I think your points of view are probably well-intentioned, but I think you may be somewhat emotionally invested in the debacle of the profit-drive in healthcare, which is a bit confusing to me. The moral end of health improvement in general (IE. wanting people to live longer, healthier lives) is noble, but your reasoning is neglecting economics...

    I read this article in National Affairs (I don't know if anybody has posted it yet or not), but I think it's pretty balanced for the most part, and demonstrates with good evidence why healthcare reform needs morals and economics (profit-motive):

    http://www.nationalaffairs.com/publications/detail/health-care-and-the-profit-motive

    Your article doesn't mention preexisting conditions or elderly people.

    Can you elaborate on that a little?

  • override367override367 misogynist/MRA/socially irresponsible Registered User regular
    edited May 2011
    Profit motive for insurance is why insurance companies have staff who do nothing but deny claims. Their profit is literally dependent on not providing the service people are paying for.

    XBLIVE: Biggestoverride
    League of Legends: override367
  • QliphothQliphoth Registered User
    edited May 2011
    You can have a functional private healthcare system. As long as it is run alongside a government funded one so that it has to remain competitive. If the private health care providers are not better than the government then people will not pay for them and just return to the free government system. So in our case profit is dependent entirely on quality of care. There are an abundance of private health insurers and the government health care is pretty good. Comparatively the American system seems set up in a way that prevents competition. It is somewhat ironic that the free market worshipers are promoting a system that is far less competitive and far more expensive for everyone.

    [SIGPIC][/SIGPIC]
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