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high cost of health care

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  • Sat, Jun 06, 2015 - 08:42pm

    #1
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    high cost of health care

This note relates to John Rubino’s comment regarding the complexity of our health care system. He is absolutely correct, because it was made that way. The cost of health care will continue to increase due to the rapid consolidation of health care systems. In my county in central Pennsylvania I am one of five Family Practice physicians who are still in private practice. There are three large health care systems who employ dozens of mid level providers and primary care physicians. Why is this happening? The federal government has granted these systems a competitive edge through various means. One is the infamous facility fee that allows a hospital system to charge an additional fee when a patient is seen by one of their physicians. Some of these fees can be quite large. This not only drives up the cost of health care, but enables them to buy struggling practices. As this occurs, patients have fewer options for their health care. They can charge exorbitant fees for basic lab and imaging, because the nearest independent lab is 40 miles away. Most patients now have high deductibles with their insurance and many simply not do basic lab testing as a result. In the 1980s most physicians had labs in their offices, a government mandated plan called CLIA slowly put these out of business. This was due to the high fees and cost of compliance. The biggest factor driving physicians out of private practice is  employer based health insurance. This granted health insurance companies monopoly like power over individual physicians. In my state the reimbursement for office visits for primary care physicians has been about 110% of Medicare for the past twenty years. The insurance companies simply tell us what they will pay us. If we do not like it then all those patient will be reassigned to another doctor. Since there is little difference in reimbursement rates between insurance companies, we simply pick our poison. Nation wide more than 70% of  all physicians will be employed in the next few years. This will be a disaster for patients, especially those with private insurance. Of course rolling back all of the above would open up the health care market and reduce costs. However there are powerful vested interests that will fight this. Most of the CEOs of these systems have the egos of their fellow CEOs in other businesses. Although they would deny it, they treat their business, health, as if it were a commodity. Unfortunately Obama Care has only made this problem worse. Only a financial meltdown will reverse this situation. As discussed by Chris and John, the longer it takes for a reset, the worse it will be for both  the health care system and the patients who depend on it.

  • Mon, Jun 08, 2015 - 09:43pm

    #2

    lambertad

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    I agree, but is there a different way?

Hey Doc,

Good to hear from you. I share your same views, but I'm in a little different boat. I'm currently in my first semester of physician assistant school out in Utah, although I'm originally from Somerset County, PA. I chose PA school over med school for several reasons – money, time, I'm already 31 years old, etc., but I would like to find a doctor to work with who runs a cash only practice. A lot of people still do not have health insurance, and a lot of patients do not want to put up with 'McService" when they do see their doctor for 10 minutes after waiting 60 minutes in the waiting room. 

My wife recently went to a cash only doctor and he literally spent 2.5 hours with her on her first appointment taking a history, exam, counseling, etc. He's the only doctor in the practice, his wife is an MA/receptionist and it's only those 2 folks in the practice. They coordinate with low cost providers for different services, labs, radiographs, etc. and they publish their costs so patients know how much each will cost before having the procedure. I'll go a little more into how the system works below. 

First, most people who go to them have a high-deductible health plan. Ours is $3000 before the insurance covers anything, but the nice thing about an HDHP is that you can have an HSA. Anyway, the cost is $1,500/year per family member and this covers unlimited office visits, unlimited procedures they can do in the office – stitches, vaccines, mole removal, wart removal, etc, and the Doctor will see you on weekends if you need an appointment and even on Sunday if it's an emergency. The $1,500/year can be paid for out of your HSA and it goes to meet your deductible – which is nice. Also, as I said, he has coordinated with different service providers for cash rates for different services – lab tests, x-rays, MRs, etc. This works for them because they have very little overhead that is typical of most primary physician's offices (some offices have 66% overhead), which is insane. Theirs is as low as 20% overhead. 

I'm not sure I want to practice in primary care, but that is the mission of the University of Utah's program and I have a desire to live up to the programs goals. However, I do not plan to practice in a traditional physician's office where I get to spent 10-15 minutes per patient visit trying to do the whole rat race thing. I'm simply not going to do it. I'm fortunate that my wife is a pharmacist and we will both be making good money when I'm finished with school, but I will work part-time if I have to. I simply refuse to buy into the medical problem management system, I want to prevent illness through education and getting buy in from my patients. I'd rather spend 45 minutes counseling a patient and coming up with a game plan to prevent diabetes than to spent 15 minutes every 3 months talking to them about their HbA1c results. 

Anyway, I'll get off my soapbox, but thanks for your comment. I'm glad you posted it and I know that people other than myself have read it. 

Lastly, for anyone wanting a great read, check out: "Healthy Competition". It's a fantastic book, the goal of which is to reintroduce competition to health care in order to bring down prices and foster a sense of transparency. Also, if you haven't done so, check out the "The Surgery Center of Oklahoma". They are a cash based surgery center who posts their prices online for an entire host of procedures, and they get worldwide business, especially from our neighbors to the north (Canada) who have to suffer under socialized medicine. Thanks again, Doc. 

Adam

  • Tue, Jun 09, 2015 - 12:07am

    #3
    Yoxa

    Yoxa

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    When I count my blessings …

[quote] our neighbors to the north (Canada) who have to suffer under socialized medicine [/quote]

I'm Canadian and I want to challenge that comment. When I count my blessings, Canada's medical care system is high on my list. VERY high.

Our family has always had competent care when we needed it. Our needs over the years have ranged from travel vaccinations to, among other things, childbirths, kidney stones, fractures and miscellaneous infections to a grandchild nearly having part of her finger amputated in an accident. She got expert care, the finger was saved and now she sometimes wins piano classes in the local music festival. I was charged for my travel vaccinations but the other care we needed did not result in bills for our family.

Our system isn't perfect, but clearly we're doing something right that the US isn't. The average life expectancy of  Canadians is three years longer than their American counterparts. Specifically, women in Canada live an average of 83 years, compared to 80 in the US; men live more than 78 years on average compared to 75 in the US.

This is so even though our medical costs constitute a smaller percentage of our GDP: 10.9% for Canada in 2013 vs 17.1% in the US. One reason for the difference is that a better percentage of what we pay goes to actual care, not just administrative overhead.

The average Canadian doesn't need to fear being bankrupted by medical bills. A Canadian who loses his/her job doesn't lose medical coverage along with it. The fact that our coverage doesn't depend on our job gives the average Canadian more freedom to look for a different position, go for more schooling, start their own business or bow out of the paid workforce for a while to care for small children, than an American whose medical coverage is tied to their employment status. On the other side of the coin, businesses have fewer administrative costs, and in some cases will feel more flexibility to lay off employees if business requires it. (They know that Joe the pipefitter's daughter's disease will still get care regardless of Joe's job status.) Those factors all have positive effects for our economy at large.

I'm not suffering under socialized medicine, I am your "friend with benefits"!

  • Sat, Jun 13, 2015 - 10:17am

    #4
    Peak Prosperity Admin

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    I agree with the Canadian

Keep your dirty yank hands off my beautiful NHS.

  • Sat, Jun 13, 2015 - 10:21am

    #5
    Peak Prosperity Admin

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    Deductables ? Insurances ?

Deductables ? Insurances ? What's this jargon ? What are all these numbers with strings of zeros in them ? Is it banking or something ?

  • Sun, Jun 14, 2015 - 07:52pm

    #6

    lambertad

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    you sound like an pensioner

Personal savings, delayed gratification, having a plan? 

Hands off my social security!

Carbon, you sound like an ill prepared pensioner. 

I'm sure "Hands off my social security" is good for the people who are still getting it, but it's not good for my generation who will never see what we put into it. It's a ponzi scheme, plain and simple. 

I don't want to take away your healthcare.

I want the freedom to chose my own healthcare and how I practice as a medical practitioner. I want the freedom to have a health savings account and a high deductible health plan. I want my patients to have that freedom if they so chose. I don't want to be pigeon holed into 15 minute chunks of time with my patients. I want to be able to spend as much time with them as we need to in order to improve their health outcomes. Sounds pretty awful when I put it that way doesn't it. 

Next time, please add something to the conversation before projecting your beliefs about what others think onto them. 

  • Mon, Jun 15, 2015 - 01:22am

    #7
    Peak Prosperity Admin

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    God bless you Nye Bevan

http://www.theguardian.com/news/datablog/2012/jun/30/healthcare-spending-world-country#data

  • Thu, Jul 09, 2015 - 05:22am

    #8
    trnnendofors45

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  • Sat, Aug 29, 2015 - 07:19pm

    #9
    Mollygrace

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  • Sun, Aug 30, 2015 - 11:36pm

    #10

    Pandabonium

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    It Isn’t Health Care – It’s Illness Care

We have "cheap" "healthcare" in Japan, but as with all such systems in the so-called first world today it isn't about keeping people healthy, it's about making profits from their illnesses.  Diagnostic machines (to help locate the next customer), surgeries, radiotherapy, chemotherapy, and of course pharmaceuticals are profit centers.   None prevent disease, many make up the fourth leading cause of death in America,  and their overall effectiveness at making anyone healthy is highly dubious.

Better to invest in your good health using information from unbiased peer reviewed studies.  Here in Japan, where I've lived for ten years having fled the US just before the second selection of GWB, I have witnessed the fact that the more people eat like Americans, the sicker they become.

With apologies to Joni Mitchell –  I've looked at health from both sides now…  most doctors don't know health at all. 

One of a handful of docs who helped me to rescued my health without surgery, drugs, or radiation:

Time to go work in the garden…

 

 

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