OK, I finally watched Moore's "SICKO"

and of course I remember all the flak he got for supposedly painting an overly rosy picture of the English, Canadian, French and Norweigan systems.

So ok, put up or shut up. Where is the documentary or study that explains that? Where is the anti-SICKO?

I'm serious, I'd like to know the other side of the story.

Originally Posted by 13rian

OK, I finally watched Moore's "SICKO"

and of course I remember all the flak he got for supposedly painting an overly rosy picture of the English, Canadian, French and Norweigan systems.

So ok, put up or shut up. Where is the documentary or study that explains that? Where is the anti-SICKO?

I'm serious, I'd like to know the other side of the story.

I can give you a perspective from someone who has a rare incurable disease, me. I belong to a national group of women who have the same disease. I read almost daily the personal posts of women who live in the USA who cannot afford their medicine, doctors or much needed labs and tests to keep them alive. There are also women on the national list who live in Canada who are saddened that so many people have to suffer and die from the lack of health care. All of those who live in Canada are seen by specialists at a moments notice and don't have to worry about paying for our expensive medicine.

I have thanked the women who post from Canada about the stark difference in health care in our countries. They have helped break the myth that so many of us in the US have been lead to believe about the long waiting lists and on and on. Maybe if you have a headache or something not serious, they may have to wait but so do most of us in this country.

It's time that the myths about universal health care are brought to light. Lives depend on it.

Just when you thought that the outrages couldn't possibly get any more blatant, comes this item:

http://www.silive.com/news/advance/i...550.xml&coll=1

It was my hope that there would be a reason to revive this thread after the election.
Well, here we are. :

Let me note that on another thread I and some others predicted that the Republicans would fight against universal access to healthcare as if the world that they know depended on it.
Well, they see it that way.

Originally Posted by Washington Monthly

...if Obama succeeds in passing health care, then people who might have been conservatives will like it, and will be more likely to vote for the people who passed it. This is unexceptional. An honest conservative might accept this claim and say: well, I guess our ideas are unpopular, so we'll just have to make our case more persuasively.

But that's not the conclusion they draw. Pethokoukis and Cannon say: because people will like health care reform, if we do not block it, our party will lose support. So precisely because people would like it if they tried it, we need to make sure that it fails.

At least they're honest about it.

It's going to be total war.
And if the Obama administration has any illusions otherwise, they will lose.

IMO healthcare should be considered a basic human right, not a commodity to be bought and sold. That people cannot get needed healthcare because they can't afford it is simply criminal.

Originally Posted by herbal tee

It was my hope that there would be a reason to revive this thread after the election.
Well, here we are. :

Let me note that on another thread I and some others predicted that the Republicans would fight against universal access to healthcare as if the world that they know depended on it.
Well, they see it that way.

It's going to be total war.
And if the Obama administration has any illusions otherwise, they will lose.

Right there is one of the filibusters I've predicted to occur over the next two years. Only this time, if we indeed be 4T, an Obama defeat on health care under such conditions will only ensure another Republican rout in the Senate (and the House) races in 2010, as an outraged public punish the guilty at the polls, while rewarding Obama for at least trying! Then, all he need do is re-introduce his Health Care bill in 2011, along with anything and everything else that got filibustered to death in 2009 - 2010.

Originally Posted by Odin

IMO healthcare should be considered a basic human right, not a commodity to be bought and sold. That people cannot get needed healthcare because they can't afford it is simply criminal.

Are you establishing "human rights" on consequentialist grounds or deriving them from the fact that we are human?

The rough draft emerges.

Originally Posted by Yahoo News/Associated Press

WASHINGTON – President Barack Obama, providing the first real details on how he wants to reshape the nation's health care system, urged Congress on Wednesday toward a sweeping overhaul that would allow Americans to buy into a government insurance plan...

...Obama has asked the House and Senate each to finish legislation by early August, so that the two chambers can combine their bills in time for him to sign a single, sweeping measure in October...

...Covering 50 million uninsured Americans could cost as much as $1.5 trillion over a decade, and cost is emerging as a major sticking point. Obama didn't offer new solutions to that problem in his letter Wednesday but did say he'd like to squeeze an additional $200 billion to $300 billion over 10 years from the Medicare and Medicaid government insurance programs for the elderly, disabled and poor.

He said he'd do it through such measures as better managing chronic diseases and avoiding unnecessary tests and hospital readmissions.

Originally Posted by SVE-KRD

Right there is one of the filibusters I've predicted to occur over the next two years. Only this time, if we indeed be 4T, an Obama defeat on health care under such conditions will only ensure another Republican rout in the Senate (and the House) races in 2010, as an outraged public punish the guilty at the polls, while rewarding Obama for at least trying! Then, all he need do is re-introduce his Health Care bill in 2011, along with anything and everything else that got filibustered to death in 2009 - 2010.

Succinct, accurate and on the mark.

Note also that Obama does big things in tandem launching a big domestic initiative simultaneous with a big international initiative. Health care at home, ME peace abroad. That gives the opposition fits.

If and when this new Federal Health Program happens, I demand the same system my Senators and Congressman currently enjoy. We can take the existing Federal worker system and use that as the base for the national plan. Next transfer MediCare/MediCaid users into the plan and use the tax money to implement this new system, no need for duplicity in care. I will be happy to get rid of my private insurance to enroll into the new Federal system, if it keeps the same tenants as enjoyed now by each Federal employee. I want to know the same amount I am paying will be the same amount or similar in the new one. Those who can pay and are not currently in plan, deal with the deductions in take home pay.

I will never wish the Military Health Care insurance on anyone since I was on it until I was 23. To take an entire day off of work since most do not have a set appointment is unreasonable and hard to explain to an employer. Believe me, if the government tells us that they will tax current health care benefits, alot of employers will opt out in paying for employees private insurance. Do it right and not rush it, Mr. President, since I want what my elected leaders have.

I just had a colonoscopy. The procedure takes 20 minutes. I figured they can do 15 a day. I saw three people, the receptionist, the nurse who prepped me and the doctor who performed the colonoscopy. That means five procedures per worker per day.

I am a research scientist for a major pharmaceutical company. My charge out was $1000 6-7 years ago, let's say less than $1500 today. This charge out accounts for salaries and benefits for the workers plus overhead costs (e.g. well equipped laboratories filled with expensive analytical equipment and expensive construction + administration costs).

So I figure if health care were run as efficiently as pharmaceutical corporation, their charge out per procedure would be $300. Now our chargeout covers our costs and all of our overheads, but not the "burden" from the corporate home office, which has many expensive executives who are paid large salaries to do mergers and restructuring, plus hundreds of center folks who have no discernable function, but incur cost, and then there are the direct acquisition-related costs. In total the burden takes about 50% of the sales dollar. You need 20 cents gross profit, which leaves 30 cents for those who actually produce the product/service. So I figured with a $300 cost, they would need to charge $1000 per procedure to cover the corporate bloat, allow for profit and cover the actual cost of doing the procedure.

I was charged a $250 co-pay and I figured the insurance company would pay about $750. This works out to a 3:1 ratio for the insurance share. For office visits I pay $20 and the insurance pays $40, a 2:1 ratio, so this seemed reasonable.

My insurance company was charged $3200 for this procedure and they paid every cent, as it was within network. Had I paid myself, they would have charged me more than $5000. The fact that the insurance company paid this amount without complaint means this is the market price for colonoscopies.

This price is ridiculous. The procedure took 20 minutes, not really different than getting four wisdom teeth removed. I had this done in 1984. I got the same IV sedation for the tooth extraction as I did for the colonoscopy. The tooth was extracted by an oral surgeon, which is equivalent to the colonoscopy doctor. I had a person prep me for both and both places had a receptionist. That is, I saw three people in both cases and the procedure took about 20 minutes. Yet I paid $750 in today's dollars (I had no insurance) versus $3200 paid by the insurance company today.

So folks who sell colonoscopies charge three times what they need to. You figure 4 million people turn 50 each year. If only a quarter of them actual get their colonoscopies that would mean a million a year. Even at $2000 a pop that translates to a two billion dollar industry. A company should be able to specialize in just colonoscopies and make a mint by charging way less than $3200 to get 100% market share.

Obviously no such companies exist or my insurance company would have found them. Why don't they exist?

This is a nutshell is the problem with health care. How on earth can health care providers get away with doing so little for so much money?

Originally Posted by Mikebert

How on earth can health care providers get away with doing so little for so much money?

Because they have a captive market.

I retired recently from a national commercial medical testing laboratory. A common chemistry test ordered on many patients is the 24-test panel comprising tests that examine several organ systems, electrolytes, enzymes, etc.

The "list price" that we charged patients without insurance was about $160. Medicare, Medicaid and insurance companies would pay about $10-15 for it. The insurance companies tend to follow the pay schedules that Medicare sets up. The amounts that the insurance companies pay out varies a bit, but none of them pay anything close to the "list" or catalog price. Doctors who purchased the test wholesale and then sold it retail to selected customers could get it for $5. The company wrote off the difference - the difference was called "disallowance." However, the poor guy who paid his own bills got no mercy; he is expected to pay the full price.

The medical industry even has a name for this travesty. It's called "cost shifting." If you've got clout, if you're a big company, you pay pretty much what you want to and the service provider writes off the rest. If you're an individual without insurance and you have no power over the transaction, you get screwed.

Socialism for the rich, free enterprise for the poor.

Originally Posted by Mikebert

This is a nutshell is the problem with health care. How on earth can health care providers get away with doing so little for so much money?

It's called a cartel. They persist because competitors are locked out of the market -- ultimately by force.

- btw, they do colonoscopies here, too. It would have cost you no more than $1500 for the plane tickets, $200 tops for the visa, $100 for the passport (assuming you don't have one already), maybe another $100 in living expenses while here, and in the neighborhood of $100 for the procedure (assuming you go to a high-quality place and pay cash up-front). So, absolute worst case, you would have been out-of pocket no more than that 2 grand you gave as a 'more reasonable' price. Wide competition on the free market makes a big difference.

Originally Posted by SVE-KRD

Right there is one of the filibusters I've predicted to occur over the next two years. Only this time, if we indeed be 4T, an Obama defeat on health care under such conditions will only ensure another Republican rout in the Senate (and the House) races in 2010, as an outraged public punish the guilty at the polls, while rewarding Obama for at least trying! ...

-Probably wishful thinking on your part; most American's don't want socialized medicine; some of the ones who are tempted, generally take a pass once they're reminded of how things work in countries that do have it (i.e. they get their dose of reality).

Originally Posted by Mikebert

How on earth can health care providers get away with doing so little for so much money?

-Because your insurance company is still making a profit.

BR's answer:

Originally Posted by Brian Rush

Because they have a captive market.

-Sort of, but not quite.

If the cost of a colonoscopy is such a concern of Mr. Bert's, then why didn't he look for a cheaper colonoscopy before he had the procedure? The reason he didn't, is the same reason that medical costs are so high; he had little incentive to find someone who would do it at a cheaper price (or more precisely, he THOUGHT he have little incentive to look around to find someone who would do it at a cheaper price).

This is a fair point, too:

Originally Posted by Justin '77

It's called a cartel. They persist because competitors are locked out of the market -- ultimately by force.

-BTW, perhaps everyone would prefer the way the VA does colonoscopies?

-----------------------------

Originally Posted by haymarket martyr

WARNING: The poster known as jamesdglick has a history of engaging in fraud. He makes things up out of his own head and attempts to use these blatant lies to score points in his arguments. When you call him on it, he will only lie further. He has such a reputation for doing this that many people here are cowed into silence and will not acknowledge it or confront him on it.

Anyone who attempts to engage with glick will discover this and find out you have wasted your time and energy on an intellectual fraud of the worst sort.

-So cry many Boomers (self-professed Lefties, mostly) whenever they fail to explain their hypocritical self-justifications, their double-standards, and their double-think forays into evil. Perhaps their consciences bother them, perhaps not. Who knows.

I personally have no problem with all Americans have access to the sort of healthcare I do as an employee of the Federal Government. That is, I get to choose the private health care plan that works best for me in terms of cost, services provided, physicians available, etc. I pay a relatively small amount per month, and my employers (the taxpayers) pay the rest... which I don't have a problem with either, as I too am a taxpayer. If the Government can also offer a basic health care plan that those who are unable to afford a stronger policy, can choose, even better.

If that amounts to socialism, so be it. Conservatives, libertarians, and single-payer liberals all be damned.

Originally Posted by Roadbldr '59

I personally have no problem with all Americans have access to the sort of healthcare I do as an employee of the Federal Government. That is, I get to choose the private health care plan that works best for me in terms of cost, services provided, physicians available, etc. I pay a relatively small amount per month, and my employers (the taxpayers) pay the rest... which I don't have a problem with either, as I too am a taxpayer. If the Government can also offer a basic health care plan that those who are unable to afford a stronger policy, can choose, even better.

If that amounts to socialism, so be it. Conservatives, libertarians, and single-payer liberals all be damned.

Ehh I was on that plan as a kid, didn't help me none. The doctors were more than happy to make prescriptions for expensive "happy pills" designed to manage symptoms. (anti-pain, anti-anxiety, anti-depression - a slew of opium derivatives were the best "professional" suggestions for digestive/auto-immune issues)

There was still no incentive on the industry's part to identify or cure underlying causes. Expanding this to everyone without reform would be incredibly expensive but would probably do little to fix our lagging public health. Its a $100 blood test that fits the WHO standards of universal testing - but why would the insurance co. and docs want to give up their best paying customer?

Originally Posted by Justin '77

It's called a cartel. They persist because competitors are locked out of the market -- ultimately by force.

How are they locked out?

Assume a couple of gastroenterologists set up their own colonoscopy shop and charge $2000 a pop? Assume their clinic is open 300 days a year and each doc works 150 days a year doing procedures. Total staff besides the docs is five, two to assist with the procedures, two to interface with customers, plus a businessperson to make deals with insurance companies and run the business. At 15 procedures per day they would have the capacity to do up to 4500 procedures annually.

With six million of these things done per year, that works our to about 5000 in Kalamazoo county alone, more than enough for a shop like the one I describe above. By charging two-thirds the going rate they should get most of the business.

Say they do 4000 procedures a year at $2000 a pop. That's $8 million in revenue. Seems like it would be a going concern.

What "force" is preventing them from doing this? Who is the cartel? I thought specialist docs made about 300-500K. The two guys in my example above ought to do helluva lot better than that.

Now I knew a lot of med students when I was in school. And for the most part they are folks like me, not every motivated by money. They don't do that because they don't particularly care to develop networths in the tens of millions. But why doesn't an entrepreneur do this? He could pay gastroenterologists $100K a year to do colonoscopies just one day a week, forty weeks a year. That is less than 10% of what he charges and the doc is by far the most expensive piece of the service he sells. The other people he can hire easily.

What is stopping him from doing this? What is stopping YOU from doing something along these lines? You are looking for a new opportunity right?

Originally Posted by Brian Rush

Because they have a captive market.

That is wrong because any business with outsize profit will draw competitors. Justin was closer with his "cartel" idea, but the math doesn't work out there either.

Here's another example that shows I am not way off here. When I see my primary care provider, I see three people too: a receptionist, a prep person and the doc. I only see them for 5 minutes instead of the 20 minutes the colonoscopy takes. Assume that the primary care doc can see 75 patients a day, five times what I estimated for the colonoscopy doc. Apply the same model I would expect the primary doc to charge $200 for an office visit instead of the $1000 I estimated for the colonoscopy.

She only charged $55. OK so she is self employed, and so does not have to have the corporate burden. And she has no shareholders and so doesn't have to make a profit. Even so her raw charge out should be $60--yet she only charged $55. How does she do it?

The answer is she doesn't anymore. She retired last year (she is my age) because it simply wasn't worth it to stay in business.

So you see my model isn't that bad. For some reason specialists who do procedures can charge 3-4 times more than the market value of their services while nonspecialists cannot.

My roomate from grad school is a doc. He did a residency in path and then did a another two years to get certified in radiology. Seems to me that a family practice MD could spend two years to get certified in gastroenterology than then join the profitable colonoscopy racket instead of the unprofitable family practice gig.

Why isn't this happening? Family practice docs are AMA members too and there are a lot more of them than the colon guys. Why do the colon guys get to shit all over the other docs?

We could ask The Rani, but these has already said she doesn't care about money so that's probably why she's a psychiatrist. I can't think if a medical practice that would have worse fundamental economics.

Originally Posted by jamesdglick

Because your insurance company is still making a profit.

That makes no sense, They would make MORE profit if they could negotiate $2000 per procedure instead of $3200.

If the cost of a colonoscopy is such a concern of Mr. Bert's, then why didn't he look for a cheaper colonoscopy before he had the procedure?

I only paid $250 bucks, which is dirt cheap. The INSURANCE COMPANY paid $3200 bucks. The insurance company has every incentive to find the cheapest provider. By doing so they got my old primary care doc to accept $55 for a 5 minute office visit. But when it comes to colonoscopies they had to shell out $3200 for a 20 minute visit. How come the colonoscopist gets 58 times more money for something that takes five times more time?

The reason he didn't, is the same reason that medical costs are so high; he had little incentive to find someone who would do it at a cheaper price

It was the insurance company who paid, and they have every incentive to bargain the lowest prices.

Originally Posted by Justin '77

- btw, they do colonoscopies here, too. It would have cost you no more than $1500 for the plane tickets, $200 tops for the visa, $100 for the passport (assuming you don't have one already), maybe another $100 in living expenses while here, and in the neighborhood of $100 for the procedure (assuming you go to a high-quality place and pay cash up-front). So, absolute worst case, you would have been out-of pocket no more than that 2 grand you gave as a 'more reasonable' price. Wide competition on the free market makes a big difference.

Of course I only paid $250 for my procedure. And you didn't count my time. I would have to take three days of vacation ($1800) to go to Russia, so the effective cost to me and my employer (who is paying for it) would be about $3800, less than the $3200 the local guys charges. So you see they ARE competitive with you Russian guys.

The question is, why aren't there local competitors? As I showed above, your "cartel" idea doesn't fit the data.

I don't shop around for a cheaper provider because I'm with a given HMO that tells me what providers I do and do not see. Unless I have a good reason not to see one (such as the primary care doc who kept giving me antacids for a condition I finally asked to see a GI specialist about - turned out to be hiatal hernia) - I don't buck a tide as strong as that.

Originally Posted by Mikebert

Of course I only paid $250 for my procedure. And you didn't count my time. I would have to take three days of vacation ($1800) to go to Russia, so the effective cost to me and my employer (who is paying for it) would be about $3800, less than the $3200 the local guys charges. So you see they ARE competitive with you Russian guys.

Bah. Schedule it for a three-day weekend (holidays here and there don't overlap, so that actually works out pretty well...) There's no reason to block out three full days, anyway. I've done the business-trip-hop in and out of here. Figure leaving the USA in the afternoon on a Friday; you arrive in Petersburg at the latest on the afternoon Saturday, do the procedure, and are on a plane back by mid-day Sunday; now the time difference is on your side, worst-case, you arrive a couple of hours later than you left, and are able to get home in time to make bedtime Sunday night so you don't even have to come in late Monday morning. It sucks to do that kind of thing over and over again in a row, but a one-off shot isn't so bad at all. And you're flying from where in the US? All the prices I gave were high-ends, assuming leaving from the US west coast; you could probably get away with a grand less than my total, easily the closer you are to the Atlantic.

Originally Posted by TnT

I retired recently from a national commercial medical testing laboratory. A common chemistry test ordered on many patients is the 24-test panel comprising tests that examine several organ systems, electrolytes, enzymes, etc.

The "list price" that we charged patients without insurance was about $160.

Actually $160 is not bad for a battery of validated assays. Our insurance companies get charged hundreds of dollars for such assays.

You guys aren't the problem because medical folks aren't the only folks who buy assays. If you charge too much we will do it ourselves. We DO a lot ourselves and send other assays out. Our cheapest assay is Monica in the RTL lab who does unvalidated general assays (with customer-provided sample prep) at a chargeout of about $50 per assay (of course she is internal to our unit so we actually "pay" nothing). You guys are way better than that, but you should be, it's your speciality.

But the problem is, if the colonoscopy guys were doing your panel they would charge a "list price" of $1500. See the difference between what you charge and they do? In your case an entrepreneur has gotten involved and brought the price down from $1500 to $160.

If the colonoscopy racket were as tightly run as the family practice, they would charge about $1000 per procedure instead of the $3200 they do charge. If they were as tightly run as you guys, it would be considerably less than that.

Originally Posted by Justin '77

Bah. Figure leaving the USA in the afternoon on a Friday; you arrive in Petersburg at the latest on the afternoon Saturday, do the procedure, and are on a plane back by mid-day Sunday; now the time difference is on your side, worst-case, you arrive a couple of hours later than you left, and are able to get home in time to make bedtime Sunday night

From Friday afternoon to bed time Sunday night is more than 50 hours. I was charging out only three days (24 hours)--half of that.

Remember, I am not saving my money, but my company's money. Why would I do it on my own time? I would do it over the work week and it would involve taking three days off.

Back in 1993 I took the laprascopic option for a hernia instead of the conventional option. The reason why is I thought the two (both three hour procedures) were about the same cost and I would be back at work two days earlier with the former. It cost $7K

As it turned the hernia recurred and I ended up having the regular procedure. And yes I was back two days earlier with the laprascopic procedure so there was truth in advertising there. But the insurance company was charged only $2K for the second procedure by the same provider. A two day shorter recovery time is not worth $5K, yet somehow the surgical provider was able to get the insurance company to pay $5K for for the same service just because it was laprascopic.