Universal Healthcare...an idea whose time has come??

[Miss Kitty]

Thanks punzey...I forwarded that to Mr. K

 

[scooterbug44]

I agree. Everyone in their district should get paid the same amount as well, whether they work or not. From each according to his abilities, to each according to his needs, that's what I always say.

How did I know you would equate this w/ communism!

I didn't say EVERYONE had to have the same, just that a good carrot for the politicians would be if they had to have the worst available standard of care in their district.

Government health care is insane. I found it hilarious that my mother as a low level state employee (admin assistant at a university) got better care/insurance for her family than my father did as a corporate executive.

 

[6thGen]

The insurance industry is bad, but their entire budgets only account for 1-3% of all money taken is as premiums. Blaming insurance companies for the cost of healthcare is like blaming local gas station owners for the price of gas. The real problem with insurance is that it keeps the market from working. Most consumers cannot tell you how much an office visit with their doctor costs, how much their monthly prescription costs, or how much their hospital charges for a level 2 outpatient surgery. Many people have the attitude that they should utilize the heck out of their insurance because it's so expensive, and it's someone else's money. The complete reliance on a thrid party payor is the biggest factor driving up healthcare costs, and since we as a people aren't demanding Healthcare Spending Accounts and high-deductible indemnity policies we only have ourselves to blame.

Of course, physician reimbursements have remained stagnant since 1996 when adjusted against the CPI. Insurance companies are limited to a percentage of premium dollars for operating budgets and profits. It's the big corporate hospitals and pharmaceutical companies that have been driving the skyrocketing costs of medical care for the past 10 years. They have lobbyists that keep Medicare from imposing a fee schedule on their products.

I used to have a great PP slide to illustrate this point...two pie charts representing healthcare spending in 1995 and 2005. The one representing 1995 was kind of small showing a little sliver slice for insurance, one-fifth to drugs, and roughly equal shares of the remainder going to providers and hospitals. The 2005 pie was much larger, still the sliver for insurance which was bigger only because the pie was larger, 15% of the pie went to providers, 40% to hospitals, and 58% to drugs.



The baby boomers will probably bring about some big changes to healthcare. As they retire, they will be required to move to Medicare primary and if they keep insurance from their employer it will be scondary. Most will have to purchase a supplement to Medicare. This year, the average Medicare reimbursement for a typical office visit (99212) is $33.18. It costs more to get a haircut with a good stylist. Medicare pays $5400 to a surgical team (5 people for 3 hours, minimum) to perform open heart surgery. As more and more people go to Medicare, it will no longer be possible for doctors to make a decent living. A practice that has 20% Medicare patients sees it as a charitable service and duty to see them. As the Medicare population swell, the better doctors will begin limiting the number of Medicare patients they will accept. As baby boomers begin to realize that they don't have access to top quality medical care, they will revolt.

Outfreakingstanding post. The only thing I'd add is how much higher costs would be if the government controlled the payments.

 

[Bob]

Who wants to be the first to say "but we have the best healthcare system in the world"?

 

[scooterbug44]

Thanks for that post!

Are the drugs making up a larger part of the equation because they cost more or are being used more (instead of surgery, therapy etc.)?

Where are the insurance companies getting money if they only get 1-3% from premiums? Is the rest coming from out of pocket payments from those they insure for items not covered? What other sources of income do they have?

As far as office visit prices vs. hairstylists. I typically see a doctor for 15 minutes maximum and a hairstylist for an hour or more.

Medicare paying a surgical team of 5 people $5400 for 3 hours work (assuming that 2/3 of that cost is removed as overhead etc) means each person on that team is making over $220,000 a year if you base their income on their lowest rate. I consider that a pretty decent living!

 

[rapunzel]

Who wants to be the first to say "but we have the best healthcare system in the world"?

I actually posted about my 20/60/20 theory of our healthcare system on another thread, but I can't find the post now. Does anyone remember which thread that was under?

 

[Bob]

Your doctor will linger a full 15 minutes?

 

[Smiling JOe]

Medicare paying a surgical team of 5 people $5400 for 3 hours work (assuming that 2/3 of that cost is removed as overhead etc) means each person on that team is making over $220,000 a year if you base their income on their lowest rate. I consider that a pretty decent living!

Can you walk us through your math on this one? Also, is a surgical team all doctors earning the same percentage? One other thing, what is the cost per year for liability insurance for a heart surgeon? I know several surgeons who "retired" early because they had to write a check for more than $100,000 per year, for liability insurance. I think they write the check prior to earning the money.

 

[scooterbug44]

Can you walk us through your math on this one? Also, is a surgical team all doctors earning the same percentage? One other thing, what is the cost per year for liability insurance for a heart surgeon? I know several surgeons who "retired" early because they had to write a check for more than $100,000 per year, for liability insurance. I think they write the check prior to earning the money.

Obviously I oversimplified the math, but:

Start w/ $5400 - assume 2/3 of that goes to overhead, liability insurance, administration etc. - $1800 left

Divide the $1800 by 15 (to get the average hourly rate for the 5 people working for 3 hours) - $120

$120 an hour x 40 hours a week x 47 weeks a year (assume 5 weeks of vacation, inactivity, fewer hours etc.) = $225,600 a year is the average salary for someone working the minimum required for "full time" employment less than 11 months a year.

That's based on the Medicare rate, which used as an example of how hospitals, drs, couldn't survive on such low rates.

Rapunzel, you posted the tiers of care in the TB thread. I'm assuming medicare is in the third tier or bottom of the 2nd.

 

[rapunzel]

Thanks for that post!

Are the drugs making up a larger part of the equation because they cost more or are being used more (instead of surgery, therapy etc.)?

There are many reasons the drugs are making up a bigger percentage. First, they do cost more. Brand name drugs still under patent typically cost between $100 and $200 for a months supply. Also, through a major lobbying effort, the drug companies have found ways to extend their patents. For instance, a company invests sleepdrugstra, they market it for seven years, as it's patent gets close to expiration, they put a coating on the tablet that makes it extended release, rename it sleepdrugstra XR, and get a patent extension. Another factor is that pharmaceutical companies have poured more of their research and development budgets into maintenance drugs -- drugs that you take everyday for infinity. Treatments are way better than cures for the drug industry, and consequently most new drugs fall into this category. In 1995, fewer than 10% of people age 25-34 were on a monthly maintenance medication, now almost 40% in that age group take a maintenance drug daily for at least three months in a given year. The biggest factor in the growth of the drug company 'pie share' is direct to consumer marketing. Drug companies were not allowed to market to consumers until 1987. Expenditures on direct-to-consumer ads have more than quintupled in the last ten years since the FDA changed the guidelines, from $700 million in 1997 to more than $4 billion in 2004. Finally, as I mentioned earlier, the drug industry was able to keep the the government from implementing any price controls of the sort doctors and other providers have had to accept via Medicare fee schedules.

Where are the insurance companies getting money if they only get 1-3% from premiums? Is the rest coming from out of pocket payments from those they insure for items not covered? What other sources of income do they have?

Premiums are their only source of income. 1-3 percent of the healthcare dollars spent in this country is quite a lot of money. As the insurance companies continue to consolidate, that number may rise to 3-5%, but it is still not the big factor in the increase in premiums.

Out of pocket payments go to the providers, not the insurance companies. The balance billing many patients are seeing more and more of is a result of the fact that many insurers now limit their payments to a percentage of the Medicare fee allowable, even for those with out of network coverage. So, if your doctor charges $50 for an office visit and your insurance pays 80% for out of network care minus a $20 copay, you may expect your insurance to pay $20 and you will pay the extra 20% co-insurance of $10. In fact, your insurance will only pay 40% of $33.18 ($26.54 - $20 copay = $6.54). The doctor will bill you for the $14.46 difference directly.

As far as office visit prices vs. hairstylists. I typically see a doctor for 15 minutes maximum and a hairstylist for an hour or more.

I do, too, but also usually pay about $150 plus tip, and a salon doesn't have a quarter the overhead of a medical practice.

Medicare paying a surgical team of 5 people $5400 for 3 hours work (assuming that 2/3 of that cost is removed as overhead etc) means each person on that team is making over $220,000 a year if you base their income on their lowest rate. I consider that a pretty decent living!

Ah, but your calculation would assume that these doctors are able to perform heart surgery 8 hours a day, 5 days week. In fact, the surgical fee also covers the pre-op and 3 to 4 post op visits as a bundle, and there is always at least one surgical consultation billed as on office visit, but more likely two or three, and the three hour figure is the minimum surgical time, not counting time for things such as scrubbing in, waiting for the staff to turn over the OR, etc. An efficient surgeon can perform 4-5 surgeries per week. Considering the expertise required to perform this surgery takes four years of med school, one year of internship, six years of surgical residency, and three years of fellowship training resulting in an average debt load of $300,000 upon completion....well, I just think you will see quantity and quality go down significantly if we move to a single payor system.