r2i forum

VS007;346659

Even though I agree with the basic principle of Tort reform, in the context of the costs, it does not reduce significant cost, CBO estimated it around 0.5% savings.

I just don't buy it. My personal experience with OB-GYNs tells me that they are practicing extremely defensive medicine all of which results into more visits to imaging centers and more C-sections. The simple childbirth can now cost few thousand dollars in imaging and upwords of $15,000 in C-section. I am pretty sure (even though they don't say it) that they have to do all this to avoid getting sued. I am not sure how CBO can calculate things like this.

returning_indian;346665This is pure economics. Even in other industries, producers give walmart very cheap products compared to other buyers because walmart buys in bulk and helps with volume. Hence the difference in rate.

This comparison is absurd. First of all, in medicine, you can't buy the product - only a licensed person can. Hell, I needed prescription to buy even Claritin once upon a time. You can't buy from out of the country (legally). You can't buy on the internet. It is a well regulated and restricted market (for a reason). You are free to buy goods that Walmart sells from anywhere in the world or manufacture them yourself if you want.

On top of that prices in Walmart are clearly posted and you know what it costs before you buy. And you don't die if you didn't buy. (May be that is not correct. Some women will die if they don't buy :)) )

returning_indian;346665
There is nothing wrong in Robin hooding.

Govt. pays very little for medicare/medicaid and no one pays anything to the hospital if they treat someone uninsured in ER. That is one (but not the only) reason why a stay in the hospital can cost 10K+ to an insured patient. I think this is wrong.

rajradio;346648
Now who is the jury, often a bunch of mechanics. The prosecutor shows a video of the family happily playing together, then the disaster happened, Infact they even make up the victim on the day of the court to make her look miserable. So what effect does this have on a jury of mechanics, fedex courier boys, admin managers and likes. " Lets hang the bas...rd making 300K", it becomes very iconoclastic. Oh wait who is the bas....rd in the room making 600K it is actually the sleazeball lawyer, he goes home OK.

It is the same jury we use to resolve a patent dispute in telecommunications, semiconductors, or high tech industry. Its not just the docs who are subject to the system. In India, the same "Lets get the bas*** driving a good car" attitude can get you in a stinky hospital of a village if you ever scrape a village kid on the highway. My point is, if you dig deep into any system, it would have some pitfalls. We have to learn to work with the system in both cases. I still do not understand what the dilemma of OP is.

The simple childbirth can now cost few thousand dollars in imaging and upwords of $15,000 in C-section. I am pretty sure (even though they don't say it) that they have to do all this to avoid getting sued. I am not sure how CBO can calculate things like this.

simple truth is they dont. I ll tell you a story. I once met a cab driver(chinese guy), who told me his story. He had a headache, but it was a headache like never before. when these words are used we are taught to evaluate for an intracranial bleed. So the guy was taken to ER, then CT was done negative, MRI was done negative, fluid was tapped from his spine negative, then cerebral angio was done negative,then a reccomendation was made to do an angio every 6 mnths. He was an accountant, but his company laid him off, so for the 2nd visit in 6 months he was bankrupt, his GF walked out, she was pregnant, now he moved from washington DC to nebraska as cabs pay better here. by the end of 7 months his out pocket bills were 30K USD.

Now most MDs know that if the CT is negative there is less than 2-3 % chance of having a bleed in the brain, but no american MD will take a 2-3% chance of being wrong due to fear of malpractice. Now if I had 97 % success in picking stocks I would be on fortune cover page. But a MD has to cover his base for the other 2-3 % make sure no lawyer goes after his life earnings. CBO has no freakin clue how much the lawyers have taken the country for hostage.


clearly reform is needed. So what I am proposing(no one cares), is we need to discipline bad MDs, the decision must be made by a group of peers (10-15 MDs in the same field very eminent, appointed by the court). not by a jury of common men.I bet my last dollar(which is not much) that lawyers will never let that happen.

RK

GutsyGibbon;346698 I still do not understand what the dilemma of OP is.

+1

Me too.. No understand..

samv;346687This comparison is absurd. First of all, in medicine, you can't buy the product - only a licensed person can. Hell, I needed prescription to buy even Claritin once upon a time. You can't buy from out of the country (legally). You can't buy on the internet. It is a well regulated and restricted market (for a reason). You are free to buy goods that Walmart sells from anywhere in the world or manufacture them yourself if you want.

Just like you need license to sell alcohol you need license to sell medical services. When was the last time you bought alcohol from unlicensed provider? You are free to buy medical services from any hospital you want! If you want to start a hospital nobody is stopping you like nobody is stopping you to manufacture anything. But you have to be licensed like any other industry.

[QUOTE]On top of that prices in Walmart are clearly posted and you know what it costs before you buy. Have you ever tried to inquire cost of any service from any doctor or hospital and they denied to disclose you?

[QUOTE]Govt. pays very little for medicare/medicaid and no one pays anything to the hospital if they treat someone uninsured in ER. That is one (but not the only) reason why a stay in the hospital can cost 10K+ to an insured patient. I think this is wrong.This socialism is due to supreme court law for emergency care. I do not think it is wrong to treat anyone for emergency care. Any rich/developed society should provide it. It will be totally inhumane to let people die on roadside due to their lack of ability to pay.

returning_indian;346714Just like you need license to sell alcohol you need license to sell medical services. When was the last time you bought alcohol from unlicensed provider? You are free to buy medical services from any hospital you want! If you want to start a hospital nobody is stopping you like nobody is stopping you to manufacture anything. But you have to be licensed like any other industry.

I don't agree. You need license to open a hair salon also. But most reasonable people will not say that hospital and hair salon are similar businesses or markets.

returning_indian;346714
Have you ever tried to inquire cost of any service from any doctor or hospital and they denied to disclose you?

I will turn back and ask you the same question. The fact is that no one can predict what hospital stay or a surgery will cost in advance. - They will have to estimate how many Dr.s will work how long, how many staplers and IV fluids will be used, how long will you take to recover, what type of pain medication and other things will you need, Will there be complications that require further treatment.

A simple Dr. consultation can be priced in advance. But a surgery and 5-day stay in the hospital maybe very difficult to price in advance under the current system and that is why no one seems to do it.

returning_indian;346714
This socialism is due to supreme court law for emergency care. I do not think it is wrong to treat anyone for emergency care. Any rich/developed society should provide it. It will be totally inhumane to let people die on roadside due to their lack of ability to pay.

There is nothing wrong in mandating emergency care. However it is fair to ask the govt. that is mandating it, to fund the fair cost of a mandate through its own budget - the cost for this mandate is not trivial. Once taxpayer start funding true cost of these mandates, they will start asking the right questions if someone is gaming the system.

Why, for example, govt. does not take SSN of those who are freeloading the ERs and start deducting the cost (at medicare rates) from their tax return? This will force people to buy insurance. Otherwise why should a healthy person buy insurance? - Just so that he can pay for all the freeloaders?

samv;346718I don't agree. You need license to open a hair salon also. But most reasonable people will not say that hospital and hair salon are similar businesses or markets.

Ofcourse not. But economics still stays the same that when you purchase things in bulk you get discounts. Hence the difference in rates for patients using insurance than self paying patients.
[QUOTE]
I will turn back and ask you the same question. The fact is that no one can predict what hospital stay or a surgery will cost in advance. - They will have to estimate how many Dr.s will work how long, how many staplers and IV fluids will be used, how long will you take to recover, what type of pain medication and other things will you need, Will there be complications that require further treatment.Well if you don't know what you need you can't price it. Have you ever tried going to a store and asked price of dinner?
[QUOTE]
There is nothing wrong in mandating emergency care. However it is fair to ask the govt. that is mandating it, to fund the fair cost of a mandate through its own budget - the cost for this mandate is not trivial. Once taxpayer start funding true cost of these mandates, they will start asking the right questions if someone is gaming the system.
Govt is not mandating emergency care. Supreme court is. There is a difference between two.

[QUOTE]Why, for example, govt. does not take SSN of those who are freeloading the ERs and start deducting the cost (at medicare rates) from their tax return? This will force people to buy insurance. Otherwise why should a healthy person buy insurance? - Just so that he can pay for all the freeloaders?Have you ever tried going to ER without insurance? Do you know the treatment in ER for people without insurance? They just make you stable and you are out of the door even if you are in pain. ER care is not something to be proud of and certainly not something you and I will prefer. Most of these freeloaders do not have income to speak of or else they would have insurance to begin with. Anyhow this new healthcare law will make it mandatory for everyone to buy insurance and that should help reduce ER visits.

returning_indian;346723Ofcourse not. But economics still stays the same that when you purchase things in bulk you get discounts. Hence the difference in rates for patients using insurance than self paying patients.
Well if you don't know what you need you can't price it. Have you ever tried going to a store and asked price of dinner?

When you go to a car mechanic you get an estimate of all repairs and cost for them. Customer can decide to go ahead with the repair or shop around for cheaper place.Why no such rule for hospitals? Only after getting EOB we come to know how expensive it was.

And the difference between individual and bulk purchase of insurance by company is too large to compare it with discount purchase in shops. It is like, we got a "bhakra" let us suck all the blood out of the fellow as he can not fight back.

Old-Spice2;346724When you go to a car mechanic you get an estimate of all repairs and cost for them. Customer can decide to go ahead with the repair or shop around for cheaper place.Why no such rule for hospitals? Only after getting EOB we come to know how expensive it was.

This reminds me of a joke. A surgeon goes to a mechanic for his car engine repair. Mechanic says to him that you and I do similar type of work (fixing nuts and bolts of engine/heart) why do you get paid million and I don't? Surgeon goes back in his car, turns it on, comes out and says to mechanic: Now work on it.

There are some things that are easy for forecast and some are not. Every patient is different. Still the fact remains that you can call ahead and find cost of CT or any other procedure you want. You can then decide if you want it or not. Unless some disease is pretty standard its cost can't be displayed. But I do agree that we need more transparency.
[QUOTE]And the difference between individual and bulk purchase of insurance by company is too large to compare it with discount purchase in shops. It is like, we got a "bhakra" let us suck all the blood out of the fellow as he can not fight back.I have negotiated with hospitals and doctor's office. They may bill $5000 but if you negotiate, they will come down to 10-20% of the actual bill and some may even waive it off. It is not as bad as it looks from outside.

rajradio;346662of course that is washington post version, who else. I am an insider, I can tell you.

Sure you are, and you are selling the AMA version.


[QUOTE]legal reform is the only way of reducing the burdensome paperwork that is breaking the system.
Single payer system is the only way to reduce the paperwork which now is burdened not by lack of tort, but because of insurance companies of getting approvals and documenting every step.
If you go to a physical therapist, they spend more time on their computers filling it in than spending time with you.


[QUOTE]
How can tv anchor in california be worth 60 million when his own life insurance policy is 600 K (few days ago he valued his own life at 600k).

There has to be a reform and upper limit set on jury award, but 500K for a permanent damage is way way too low. And the whole idea of tort reform as the panacea is a fallacy.

We need to address the real cost in the healthcare which are:
1. Hospitals and medical provider overcharging. As some one mentioned the MRI on the same equipment is ten times higher here and some 100 times for one without insurance.
2. Insurance cos profits which are in billions now. With multiple of insurance companies all paying millions to their CEOs, and their high operating costs are a duplication with so many around adding no value.
3. Drugs: When the same pfizer can sell the drug at half or 1/3 the cost to Canada, they have no reason t charge higher prices here.
In many of these cases, the free market is suppressed and protection for doctors(AMA reducing the number of doctors and H1Bs), insurance cos(no across state buying), pharmas( Bush restricted negotiation and Obama gave them deal to prevent Jack and Jill ads (sic))

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CBO people are professionals just like computer engineers and Doctors. A person of one profession cannot doubt some one from other profession esp a body of repute just because he disagrees with their findings. If that standard is applied any layman with no background in medicine can claim to disbelieve the findings of research published in New England journal of medicine.
At the end of the day, if members think they are better than expert accountants and financial assistants working for non partisan Congressional Budget office and know better, please provide your accounting credentials and a detailed rebuttal and be open for peer accountant review. Saying simply "I dont buy it" is like me saying to a Doctor after his prognosis just because I saw it on the net and I dont believe your science.