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Posted: 6/28/2012 4:52:52 PM EDT
[Last Edit: 6/28/2012 5:00:13 PM EDT by mcantu]
it seems like healthcare is the only industry where the more people buy your product, the more expensive it gets over the long term.  lets say the number of people getting cholesterol blood work done shoots up...do the costs of the test get lower over time as more units are sold?  doesnt seem like it.  is it because there really isnt a competition factor here to encourage price reductions?





am i wrong with this impression?



ETA:  Lets say private practice doctors offices and clinics only

Link Posted: 6/28/2012 4:56:31 PM EDT
New technology and moral hazard.
Link Posted: 6/28/2012 4:58:00 PM EDT
Lawyers.

Link Posted: 6/28/2012 4:58:34 PM EDT


You're assuming everyone who uses it pays.

Link Posted: 6/28/2012 4:58:41 PM EDT
Not everyone pays.
Link Posted: 6/28/2012 4:59:15 PM EDT
Supply of docs vs number of patients.

And electronic records have slowed us down and cost a gob.

Many other factors.

CP
Link Posted: 6/28/2012 5:02:18 PM EDT
Supply and demand.

As demand for a service with fixed quantity increases, so does price.


 
Link Posted: 6/28/2012 5:04:47 PM EDT
Supply/demand.

But, we already sort of have a "single payer" system as it is.

If you can't afford to pay your bill, everyone else with insurance or that can afford to pay, basically picks up your slack. The cost of non-payers is paid by those that can pay.
Link Posted: 6/28/2012 5:06:05 PM EDT
Because there is never enough money to be made.
Link Posted: 6/28/2012 5:06:12 PM EDT
[Last Edit: 6/29/2012 8:28:18 PM EDT by Dan_Cooper]
Because the health care industry hasn't been a free market for quite some time now (since the late 1960's certainly).  You have Medicare and Medicaid which amount to an enormous percentage of health care dollars being spent by the government, then you have third party payers such as insurance companies which are paying for routine rather can catastrophic medical care.  In almost all cases, the person contracting the service and the entity actually paying the bill are different parties.  That will never lead to efficient spending, no matter what industry you look at.


In the islands of the health care industry that still are free markets, like cosmetic surgery and LASIK eye surgery you see that as more people get these procedures the cost actually go down going forward, as you would expect in any normal market.






Link Posted: 6/28/2012 5:06:28 PM EDT
Because the mere existence of health insurance increases medical expenses overall by enabling people to get more healthcare than they need.

Type II diabetes/high blood pressure/high cholesterol/obesity can be managed with diet and excercise, but, fuck it, there's a pill for that.
Tobacco is harmful to your body in the long term, but there will be oxygen tanks when you get emphysema.
Your tummy hurts?  Just go to the doctor.  It'll only cost you are $25 copay.
You are poor and have nothing to do but make babies on Medicaid's dime?  No problem.  My mom's ex-foster kid is on his 4th kid at about 22-23 years old and probably makes minimum wage.

The list goes on.
Link Posted: 6/28/2012 5:06:54 PM EDT
[Last Edit: 6/28/2012 5:07:31 PM EDT by JonJR]
doc make about 600 bucks for a gall bladder surgery. the majority of the bill goes to the hospital and useless CEOs and lawyers.

you also have to pay for those that dont pay and illegals
Link Posted: 6/28/2012 5:07:34 PM EDT
Lawsuits, technology, and those who do not pay.

Link Posted: 6/28/2012 5:07:35 PM EDT
Originally Posted By h3smith:
Supply/demand.

But, we already sort of have a "single payer" system as it is.

If you can't afford to pay your bill, everyone else with insurance or that can afford to pay, basically picks up your slack. The cost of non-payers is paid by those that can pay.


And those of us who pay cash subsidize those of you who have insurance companies that only pay a percentage of what it actually costs.
Link Posted: 6/28/2012 5:08:41 PM EDT
[Last Edit: 6/28/2012 5:10:03 PM EDT by Kelty]
New technology and moral hazard.

The per unit cost of a cholesterol test will go down as the volume increases.

Part of the problem lies in new fangled tests that are exhorbitantly costly yet only provide a questionable and/or marginal benefit.

Since the insured only pay a simple co-pay or even percentage for this new test, and refuse to be told the test is only marginally better, the insurance companies end up covering tests (procedures, drugs, etc.) that can cost ten times as much as the old one with little additional benefit. The companies that create these products know they can charge top dollar because they know the insurance co's will end up paying it.

There is also the issue of general over-utilization due to people being shielded from the actual costs of the health care they receive.

There of course is more to it than that but those are some big drivers.
Link Posted: 6/28/2012 5:09:02 PM EDT
Originally Posted By SplintNicket:
Originally Posted By h3smith:
Supply/demand.

But, we already sort of have a "single payer" system as it is.

If you can't afford to pay your bill, everyone else with insurance or that can afford to pay, basically picks up your slack. The cost of non-payers is paid by those that can pay.


And those of us who pay cash subsidize those of you who have insurance companies that only pay a percentage of what it actually costs.


You can negotiate with your doctor.

Hell, my business partner is a surgeon and he'd rather take straight cash.
Link Posted: 6/28/2012 5:09:08 PM EDT
you cant just hire doctors like you can factory workers.  it takes consideral talent and significant time for them to go through school.
Link Posted: 6/28/2012 5:10:56 PM EDT
Originally Posted By h3smith:
Originally Posted By SplintNicket:
Originally Posted By h3smith:
Supply/demand.

But, we already sort of have a "single payer" system as it is.

If you can't afford to pay your bill, everyone else with insurance or that can afford to pay, basically picks up your slack. The cost of non-payers is paid by those that can pay.


And those of us who pay cash subsidize those of you who have insurance companies that only pay a percentage of what it actually costs.


You can negotiate with your doctor.

Hell, my business partner is a surgeon and he'd rather take straight cash.


Nope, most times you can't. They have a cash price, period.

This has been my experience around here.  That's if you can even find out the price beforehand, many times they have no clue and say , "we'll bill you!".
Link Posted: 6/28/2012 5:13:12 PM EDT
It probably costs YOU more because your not one of the preferred classes of people or one of the preferred races or voting blocks.

I've worked in Health care for 20+ years........I can tell you why it costs YOU more, but I'd get kicked off  the board.


Link Posted: 6/28/2012 5:13:15 PM EDT



Originally Posted By Dan_Cooper:


Because the health care industry hasn't been a free market for quite some time now (since the late 1960's certainly).  You have Medicare and Medicaid which amount an enormous percentage of health care dollars being spent by the government, then you have third party payers such as insurance companies which are paying for routine rather can catastrophic medical care.  In almost all cases, the person contracting the service and the entity actually paying the bill are different parties.  That will never lead to efficient spending, no matter what industry you look at.





In the islands of the health care industry that still are free markets, like cosmetic surgery and LASIK eye surgery you see that as more people get these procedures the cost actually go down going forward, as you would expect in any normal market.


This is the correct answer.



 
Link Posted: 6/28/2012 5:14:19 PM EDT
A lot of the cost increases because of new technology breakthroughs, but it goes up an equal amount because a lot of parasites think that health care should be "free"/paid for by someone else.

I like this analogy when it comes to cost. Which type of healthcare would you choose, a 1950's level of healthcare? or a 2012 level of healthcare?
Link Posted: 6/28/2012 5:14:33 PM EDT
People buy more of it (healthcare services) because they are largely removed from the payment process - people pay for insurance and then don't generally pay a full bill at the time of service.  They don't know what the services cost and so can't make an informed decision about whether or not they want a particular service performed, so (since it is already "paid for" by insurance), they say they want it...  When the doc tells you "you have a 0.01% chance of having cancer, do you want us to run the test" you will say yes, becuase the doctor doesn't say "and by the way, the test costs $5,000 and you have to pay for it."  

Because everyone wants every test, the standard of care (the standard of practice that must be practiced by doctors to avoid legal liability) is pushed up because the running of the test becomes the new standard.  Thus, there is constant pressure to run more and more new tests, even when totally unnecessary and not financially justified.  This puts upward pressure for doctors to leave behind older cheaper tests in favor of newer more expensive tests that cover the same issue in a marginally different way.  

The only way to reverse this trend is to get the patient back into the position of looking at the financial piece of what they are buying.  Then, people will start to decide that perhaps it isn't worth $5k to eliminate a very remote possibility of some bad outcome.  Or, perhaps it isn't worth $100 per pill to buy the latest and greatest drug for your illness when the $1/pill drug that is 95% as effective is good enough.
Link Posted: 6/28/2012 5:19:28 PM EDT
Originally Posted By Lawyerman:
People buy more of it (healthcare services) because they are largely removed from the payment process - people pay for insurance and then don't generally pay a full bill at the time of service.  They don't know what the services cost and so can't make an informed decision about whether or not they want a particular service performed, so (since it is already "paid for" by insurance), they say they want it...  When the doc tells you "you have a 0.01% chance of having cancer, do you want us to run the test" you will say yes, becuase the doctor doesn't say "and by the way, the test costs $5,000 and you have to pay for it."  

Because everyone wants every test, the standard of care (the standard of practice that must be practiced by doctors to avoid legal liability) is pushed up because the running of the test becomes the new standard.  Thus, there is constant pressure to run more and more new tests, even when totally unnecessary and not financially justified.  This puts upward pressure for doctors to leave behind older cheaper tests in favor of newer more expensive tests that cover the same issue in a marginally different way.  

The only way to reverse this trend is to get the patient back into the position of looking at the financial piece of what they are buying.  Then, people will start to decide that perhaps it isn't worth $5k to eliminate a very remote possibility of some bad outcome.  Or, perhaps it isn't worth $100 per pill to buy the latest and greatest drug for your illness when the $1/pill drug that is 95% as effective is good enough.


Well said.

And Obamacare will aggravate this situation in a major way.
Link Posted: 6/28/2012 5:19:47 PM EDT
lets say the demand for healthcare dropped by 50%...people just said 'screw it; i aint going.'  would costs drop or would prices be raised to make up for less office visits/tests, etc?
 
Link Posted: 6/28/2012 5:20:26 PM EDT



Originally Posted By DragoMuseveni:



You're assuming everyone who uses it pays.





That's a bingo.  You're adding the people who get shit for free.



 
Link Posted: 6/28/2012 5:23:57 PM EDT
Originally Posted By Dan_Cooper:
Because the health care industry hasn't been a free market for quite some time now (since the late 1960's certainly).  You have Medicare and Medicaid which amount an enormous percentage of health care dollars being spent by the government, then you have third party payers such as insurance companies which are paying for routine rather can catastrophic medical care.  In almost all cases, the person contracting the service and the entity actually paying the bill are different parties.  That will never lead to efficient spending, no matter what industry you look at.


In the islands of the health care industry that still are free markets, like cosmetic surgery and LASIK eye surgery you see that as more people get these procedures the cost actually go down going forward, as you would expect in any normal market.

This. Exactly.




Link Posted: 6/28/2012 5:24:05 PM EDT
Originally Posted By h3smith:
Supply/demand.

But, we already sort of have a "single payer" system as it is.

If you can't afford to pay your bill, everyone else with insurance or that can afford to pay, basically picks up your slack. The cost of non-payers is paid by those that can pay.

Like uninsured motorists item on insurance coverages

Link Posted: 6/28/2012 5:24:52 PM EDT
Originally Posted By mcantu:
it seems like healthcare is the only industry where the more people buy your product, the more expensive it gets over the long term.

You're forgetting the artificially limited supply.  Any product that doesn't have enough supply has a higher price.  It's one of the four basic laws of supply and demand.z
Link Posted: 6/28/2012 5:25:06 PM EDT



Originally Posted By happycynic:





Originally Posted By DragoMuseveni:


You're assuming everyone who uses it pays.





That's a bingo.  You're adding the people who get shit for free.

 


what about at private practice clinics, etc that require payment at the time of service?  



 
Link Posted: 6/28/2012 5:25:31 PM EDT
Price doesn't go up because more people ''buy'' it.  Just the opposite - with 40% of Americans uninsured, suddenly the lab is eating the costs of more uninsured folks using the lab.   That doesn't count the insurance companies saying "Nah, we're just going to pay 10% of what you're billing" and getting away with it.

If everyone actually paid, it probably would come down.
Link Posted: 6/28/2012 5:25:38 PM EDT
Don't forget the rampant abuse of the student loan system leading to a medical degree that costs $500,000.

Link Posted: 6/28/2012 5:45:17 PM EDT
Originally Posted By mcantu:
lets say the demand for healthcare dropped by 50%...people just said 'screw it; i aint going.'  would costs drop or would prices be raised to make up for less office visits/tests, etc?  


If you want to fix healthcare costs permanently you have to move in the exact opposite direction the government is pushing everyone.

You would have to remove all incentives for any insurance except for say catastrophic plans that kick in only after a single incident cost exceeds $20,000 or so. Beyond that all that needs to be fleshed out is a standard HSA plan. Reintroduce the market back into healthcare and costs will drop like a rock.
Link Posted: 6/28/2012 5:48:53 PM EDT
Originally Posted By NotIssued:
Price doesn't go up because more people ''buy'' it.  Just the opposite - with 40% of Americans uninsured, suddenly the lab is eating the costs of more uninsured folks using the lab.   That doesn't count the insurance companies saying "Nah, we're just going to pay 10% of what you're billing" and getting away with it.

If everyone actually paid, it probably would come down.


Yep.
Link Posted: 6/28/2012 5:53:51 PM EDT
[Last Edit: 6/28/2012 5:54:40 PM EDT by Dark_Harvest]
Or, here's a crazy idea... You can't pay up front, you get no service.

Ya know, like most other businesses.
Link Posted: 6/28/2012 5:56:41 PM EDT
OP - no insult, but your premise is flawed.  
 
Link Posted: 6/28/2012 6:02:42 PM EDT
[Last Edit: 6/28/2012 6:05:19 PM EDT by neshomamench]
If you want to be honest about it, because medical care is a limited commodity not a product with a lot of hands in the cookie jar as it makes its way to the end user.

It doesnt have to be that complicated to understand, in spite of the complexity of the details.

If you have 10 doctors and 100 people who use those 10 doctors...in theory, the market will set a price. If you add 50 people who need those doctors, the price goes up. There is no economy of scale here. The number of doctors is fairly fixed, the market is not competing for customers it is competing for a resource. When a business has to compete for you to buy their product, price tends to fall. When business has to compete to buy a raw good to make something, the price of that good rises. In general we are competing for the doctors. They are not competing for us.

It gets even worse.

In years past, most doctors have been men...men who work 60-100 hour weeks for most of their careers. Take a look at Medical School enrollments, half are women. Now dont get me wrong, a woman can be just as good a doctor as a man, but she, on average, is going to work far fewer hours. You also have an aging doctor population and the fact that it take 11-20 years (from day one of college) to turn out a doctor that is capable of practicing independent medicine, you cant solve this problem fast.

So, you have about the same number of doctors, who dont work as much as they used to....and a lot more people need them. Oh, an layers of non medical types that manage, administrate and whatever their cut. Add in the cost of new technology which is always evolving....that is why the cost of medicine rises with use and doesnt go down...it is a commodity not a product.
Link Posted: 6/28/2012 6:03:17 PM EDT







Originally Posted By Dark_Harvest:




Or, here's a crazy idea... You can't pay up front, you get no service.
Ya know, like most other businesses.




This is what we do in our urgent care. Because of insurance, it's not a true free market. But, if you're uninsured, you pay $99 before you come through the door. No $99, no see. It helps people decide if they're feeling sick enough to want to pony up $99.

 









If you're on Medicaid and have a piddling $3 co-pay, you will pay that $3 before you come through the door, and you'd better have your ID and current Medicaid card, or no see. We've had people go absolutely berserk when they were told that they must pay their $3. These are people with iPhones, acrylic nails, and stinking of cigarettes. Some of them are under the mistaken impression that we are an ER and are required to see them. It's almost a pleasure to help with the re-education process.

 
 
Link Posted: 6/28/2012 6:44:06 PM EDT
Originally Posted By mcantu:

Originally Posted By happycynic:

Originally Posted By DragoMuseveni:
You're assuming everyone who uses it pays.


That's a bingo.  You're adding the people who get shit for free.
 

what about at private practice clinics, etc that require payment at the time of service?  
 


People going there aren't the problems. Emergency care at hospitals and rides in the amberlamps. These are some of the most abused and leading drivers of healthcare on the non-paying patient end. Have you ever been to an ER in a city? The kind of reasons that some people go there for are full-retard. We are talking things that a pharmacist can solve... and you can't turn them away.

Hell have some paramedic chime in on vagrants and old people that ride just because they are crazy or lonely. Ask them how more people ride on rainy days.

More minor meds and clinics would help reduce the cost of healthcare.
Link Posted: 6/28/2012 6:55:22 PM EDT



Originally Posted By mcantu:




is it because there really isnt a competition factor here to encourage price reductions?





As country gets older and fatter, they have more problems. Thus more medical procedures, pills, etc., is being purchased, and the number of payers into the system is not keeping up.



 
Link Posted: 6/28/2012 7:01:18 PM EDT
Because people want to see doctors when a nurse practitioner or just a nurse would work for most purposes.  Increasing demand on a limited supply of professionals increases costs.
Link Posted: 6/28/2012 7:46:43 PM EDT
Originally Posted By happycynic:
Originally Posted By DragoMuseveni:
You're assuming everyone who uses it pays.
That's a bingo.  You're adding the people who get shit for free.  
Currently, Medicare pays ~90% of the cost of a procedure. Hospitals make up the rest on the private insured and private pays. The figures I've seen is that the new 32 million will be on 0bamaCare will have a reimbursement of ~60% of costs. Since they're use to getting free shit, money from 0bama's stash, and reparations; they will now prop up in a room with their finger through the call light demanding more pain medicine or food for their grandkids and demanding to see administration since the RN insulted them by not stepping and fetching fast enough for them. So, you're going to have more patients with a less than cost coverage and fewer patients with private pay to cover it. And they take up an inordinate amount of time with their demands which leads an aging nursing staff to just say PHUQUE IT and get out of nursing.

Yeah, I've seen enough of that already. BTDT.


<a lot of stuff deleted to keep me from being kicked off due to a CoC violation>

Link Posted: 6/28/2012 7:55:36 PM EDT
found this article from 2005.  apparently until not too long ago, the AMA lobbied Congress to limit the number of medical residencies because they were worried that there would be too many doctors...



http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm


 
Link Posted: 6/28/2012 7:59:06 PM EDT
Originally Posted By mcantu:
lets say the number of people getting cholesterol blood work done shoots up...do the costs of the test get lower over time as more units are sold?  


No. The more people that go in to get their cholesterol checked the more people accidentally end up with an amputated foot. Then the lawsuits being and malpractice insurance goes up so the more they have to charge for cholesterol tests.

Link Posted: 6/28/2012 8:07:55 PM EDT
[Last Edit: 6/28/2012 8:09:33 PM EDT by neshomamench]
Originally Posted By mcantu:
found this article from 2005.  apparently until not too long ago, the AMA lobbied Congress to limit the number of medical residencies because they were worried that there would be too many doctors...

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm
 


Yes, this is true.

The real issue here and the things that most people have no idea about, is the government is the limiting factor when it comes to the number of doctors (regardless of what proactive doctors wanted)

You can crank up medical school numbers starting right now.....but that doesnt really help any. You have to have a residency slot for those graduating medical school. The government funds most of those residency slots. That is your bottleneck.

As it stands, there is somewhat of an equilibrium. I.E. the number of medical school graduates seeking residency have a residency slot. (it is fairly complicated but that is true enough) It should also be noted that medical school graduates compete, viciously for the more competitive residencies. Not everyone gets to be a neurosurgeon (or the actual most competitive residencies are things like dermatology and radiology...while some surgeons make the most money, things like dermatology and radiology offer the best income to free time)

Graduating from medical school does indeed give you the title of "Doctor" (MD/DO) but you are not fully licensed to practice medicine yet nor are you any specific kind of doctor (Oncologist, various kinds of Surgeons, whategver...)  That is your "on the job training" and once you are done with residency you may sit for your boards (you actualy obtain your full medical license somewhere in the middle of residency)  Residencies range from 3-7 years with non surgical specialties being shorter and neurosurgery being the longest (7) years. There are fellowships after residency that some people do that last 1-4 years. After all of that...THEN you have a fully functional doctor.

You want more doctors, you have to have more residencies and unless you want to open up more of them (they already take some) to Doctors trained in other countries, you are looking at 11-20 years before you start to see more doctors.
Link Posted: 6/29/2012 8:26:35 PM EDT
Originally Posted By Mullah_Atari:
Because people want to see doctors when a nurse practitioner or just a nurse would work for most purposes.  Increasing demand on a limited supply of professionals increases costs.


In some cases, sure.

Mid level practitioners would probably get more traction on gaining more autonomy if they would draw a line when it comes to scope of practice instead of trying to keep pushing it. The "who gets to be called doctor" issue is also one that is going to keep MD/DOs pushing back hard....and in general, they will have the upper hand.
Link Posted: 6/29/2012 8:28:08 PM EDT
Supply and demand?
Link Posted: 6/29/2012 8:29:41 PM EDT
Don't expect it to operate like a free market - it ain't, at all - and that was well before obamacare came on the radar.
Link Posted: 6/29/2012 8:50:00 PM EDT
what does i have to do to become one of those people that doesnt have to pay to use hospital ER rooms, where you don't have to have a SS# to be seen??/?
Link Posted: 6/29/2012 8:50:29 PM EDT
[Last Edit: 6/29/2012 8:51:35 PM EDT by RogueSpear2023]
Well only about 75% actually pay so if 25% the people going into a store were stealing everything they went into get the rest of us would have to pay more for the items they were stealing. Also the fact that we have allowed lawyers to get heavily involved when it comes to suing a doctor for making a mistake they are human they make mistakes but when you make a mistake at your job most of the time some one can't turn around and sue you 5-10 million dollars and a win almost every time. This causes the cost of malpractice insurance has skyrocket, so that means the doctors have to charge more. So it's really a lot more complicated than supply and demand.
Link Posted: 6/29/2012 9:06:49 PM EDT
Originally Posted By mcantu:
it seems like healthcare is the only industry where the more people buy your product, the more expensive it gets over the long term.  lets say the number of people getting cholesterol blood work done shoots up...do the costs of the test get lower over time as more units are sold?  doesnt seem like it.  is it because there really isnt a competition factor here to encourage price reductions?

am i wrong with this impression?

ETA:  Lets say private practice doctors offices and clinics only



Why, because we are not god damned robots on a fucking assembly line! I can only get to so many patients in a night. Then every time a new agency comes around we need to do more bullshit charting/cataloging/indexing/stats then actual patient care.

Also, your not "buying a product", you are using a service. Stop thinking that this is mass production. The very vast majority of medicine is in labor, materials are not the limiting factor.

Technology: Every time a new piece of technology comes out, we have a limited time to get it ingrained in the system or risk liability for not providing "best practice" medicine.
Link Posted: 6/30/2012 11:58:35 PM EDT
Health care is a commodity, just like a Big Mac, or an iPhone. As technology improves costs should go down. But health care is not a free market, not at all.

We already have socialized health care via regulatory proxy. Those that can pay are told they have a moral duty to pay for those than cannot pay. This is why health care costs are skyrocketing,

Obama care goes into full effect in 2014..  what till you see the price then. I just checked the price to give me three kids the minimal insurance as allowed by the new law. $450 a month!
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