Doctor suing to reverse law raising health care costs

jaeger19 · Aug 6, 2018

ludin said:
You seem to think that because it sits in a hospital a 500 test should cost 40k. It is what we call unethical price gouging.
.

Because they sit in a hospital.. I KNOW. that test does not cost 40k.. because the hospital charge is meaningless most of the time when they are in the hospital.. because the hospital is being paid in all likelihood on a prospective payment basis. and that probably means a DRG payment.. which means that the hospital will get a set amount based on regardless of the charges, how much they do, and how long the person stays.
So.. first I know that the charge is essential meaningless.

Also.. I know because they sit in a hospital.. that hospital is paying for all sorts of stuff that is available to that person.. IF they need it.. which means that there is a cost to having equipment available and staff available on the off chance that its necessary for care.
and so that hospital has to shift costs so that it can pay for that equipment.

Also I know that because they sit in a hospital.. that hospital is MANDATED by LAW.. to provide care regardless of ability to pay.. which means.. that hospital has to also shift costs to deal with non payers.. and I also know that reimbursement to hospitals for that indigent care.. does occur and very very rarely ever meets their costs.

Also.. while you wax on "competition and free market lowering costs with people choosing to go to that lower costs MRI". I know that is largely a pipe dream because the fellow sitting in the hospital is there because in generally he is really sick and or injured and he is not capable of leaving the hospital to go to an outpatient MRI and then coming back.. He is going to go downstairs to the MRI in the hospital.

You assume people are stupid. We are not. I have shown plenty. In fact I posted two links that show enough.

Nope.. I know when people are ignorant. and those two links you posted showed ignorance of HOW the medical system works.

You just ticked that I want to remove the medical industry ability to scam people.

The irony here is that I have shown you a way that the medical industry does scam people.. with self referral for profit and overutilization of services.. .and you are arguing that it doesn;t occur and if it did.. somehow the medical board is going to catch it.

Here is the real rub... there is scamming that goes on.. now some of that is outright .. trying to get profit... but in many cases.. that "scamming".. is in response to poorly thought out solutions to healthcare by people who don't understand how healthcare works.

for example.. you are focused on the hospital charge, and what catastrophic care is.. ... but have no understanding of what that really means.. So your so called solutions.. will make things worse for the most part.

Sure there are some bad doctors out there over charging people, however they are not the norm.

Studies actually show that when there is referral for profit.. it generally happens at a significant level.

Some doctors order an MRI to be sure. Even if it shows nothing paying 500 is better than 40k.

and O is better than 40k.

If I have a doctor do as you said want another one. Why would I not get a second opinion?

Well.. first.. how would you know that the MRI was unnecessary? You have that medical knowledge? No..

So that means that you are going to get a second opinion whenever a doctor orders an MRI? that makes no sense and will cost you a ton of money needlessly.

In order to prove your case you would need to provided that the majority of them were not needed which you can't do.
You cry and whine about profit while defending 40k dollar mris that cost at most 500

Actually the studies did prove that a significant portion of them were not needed.

No where did I say set prices stop lying.

Nope.. not lying at all. You just don't understand the ramification of what you just proposed. IF the medical board is going to censure a physician for what they charge.. then they ARE setting prices. Just no way around that.

jaeger19 · Aug 6, 2018

You overcharge people for procedures.

Well.. since I have the lowest charges in all of my markets.. I would disagree... but then you have no idea what charges are and what they are not.. so its a useless discussion.

No it doesn't. Yes it is a fixed cost.

No its not a fixed cost.

Yes you do. I have already shown the medical industry is ripping people off.

Actually I provided the evidence of the medical industry "ripping people off".. when it comes to referral for profit.

Which you denied.

then you assumed that a 39k charge is ripping people off... when that charge is essentially meaningless.

You rice gouge people high prices on things that do not cost that. The insurance companies then turn around and complain of higher prices and then raise rates.

Actually.. the insurance companies negotiate a much better rate.. and so does the government.. and they actually reimburse less per procedure than they have in the past.. so what we get per procedure is the same or LESS than before. THEN the insurance companies point to the charges.. which are meaningless because they are not the allowables.. and tell you.. THATS why they are jacking up your rates...

When the reality.. is that since 1998 there have been multiple legislative actions.. all the way up to and including obamacare.. that have decrease reimbursement to providers to control healthcare costs... BUT there has been little to nothing to control healthcare insurance costs.. So the insurance companies make out like bandits.. and folks like yourself that have no clue about the medical system and what actually goes on.. think its the medical system.

HEck.. that's where you get people stating "we need to get the insurance companies out of here and go to single payer.. like medicare"... not knowing that private insurance companies already administer Medicare and in fact public insurances are a huge money maker for private insurance companies.

No I understand it just fine,

Nope.. you have proven you do not. Multiple times.

Yes we can because when we refuse to pay your 400%+ markups you will lower them.

First.. you aren;t paying them.. in fact.. no one really is. Because the insurance company doesn't allow that. IF they do.. its because they have negotiated another procedure to be lower.. so that overall reimbursement balances out in the insurance companies favor.

It puts the power back into the attention doctor hands.
I get the best price possible.

Nope you don't. but you won't listen to facts... so have a good day.

Slavister · Aug 14, 2018

Just wanted to say jaeger19 is wiping the floor on this thread. I don't know as much on this topic, but I do know some, and that is completely in line with what jaeger19 is saying.

When docs have financial motive to be more aggressive (or "defensive" if you like), not all but MANY will take it. jaeger19 quoted a couple studies confirming this too. You can't really blame them either. Same applies to most people in most other professions. They are humans. Many go into the profession for the money. Many had no or small income and only large debt until mid 30s with promise of making a ton afterwards. (The whole system IMO is setup with a bit of a wrong incentive.)

Ethics boards do have conflicts of interest, and as jaeger19 describes, most issues will never get there in the first place.

jaeger19 said:
HEck.. that's where you get people stating "we need to get the insurance companies out of here and go to single payer.. like medicare"... not knowing that private insurance companies already administer Medicare and in fact public insurances are a huge money maker for private insurance companies.

I will disagree with this one though - administrative costs of dealing with multiple insurance companies and many plans within each one are an unnecessary burden. Yes, private insurance companies are making money on this, but that's also the money that could be saved if we did not have the private insurance companies. This is one reason other countries have lower costs for healthcare. I know jaeger19 disagrees and states it's really only because they provide less services in other countries, but that's a discussion for another thread...

jaeger19 · Aug 14, 2018

Slavister said:
Just wanted to say jaeger19 is wiping the floor on this thread. I don't know as much on this topic, but I do know some, and that is completely in line with what jaeger19 is saying.

When docs have financial motive to be more aggressive (or "defensive" if you like), not all but MANY will take it. jaeger19 quoted a couple studies confirming this too. You can't really blame them either. Same applies to most people in most other professions. They are humans. Many go into the profession for the money. Many had no or small income and only large debt until mid 30s with promise of making a ton afterwards. (The whole system IMO is setup with a bit of a wrong incentive.)

Ethics boards do have conflicts of interest, and as jaeger19 describes, most issues will never get there in the first place.

I will disagree with this one though - administrative costs of dealing with multiple insurance companies and many plans within each one are an unnecessary burden. Yes, private insurance companies are making money on this, but that's also the money that could be saved if we did not have the private insurance companies. This is one reason other countries have lower costs for healthcare. I know jaeger19 disagrees and states it's really only because they provide less services in other countries, but that's a discussion for another thread...

The problem with your theory is that you fail to realize that MEDICARE.. a federal program and MEDICAID.. another federal program

ARE ADMINISTERED BY MULTIPLE PRIVATE INSURANCE COMPANIES.

You say "it could be saved".. sure.. but then.. you would have to have create your own private government insurance company to administer Medicare and Medicaid..

S

Slavister · Aug 14, 2018

jaeger19 said:
The problem with your theory is that you fail to realize that MEDICARE.. a federal program and MEDICAID.. another federal program

ARE ADMINISTERED BY MULTIPLE PRIVATE INSURANCE COMPANIES.

You say "it could be saved".. sure.. but then.. you would have to have create your own private government insurance company to administer Medicare and Medicaid..

S

First, it's not a problem. And second, it does not have to be a "private government insurance company" - that phrase does not even make sense. It could be a public government agency, just like it is in much the rest of the civilized world.

jaeger19 · Aug 15, 2018

Slavister said:
First, it's not a problem. And second, it does not have to be a "private government insurance company" - that phrase does not even make sense. It could be a public government agency, just like it is in much the rest of the civilized world.

Well.. yes it is a problem. You know have to create a whole different public agency. While getting rid of all healthcare insurance companies...

Just how much political support you think you are going to get for that?

ludin · Aug 15, 2018

jaeger19 said:
Nope you don't. but you won't listen to facts... so have a good day.

we know you don't listen to facts.

ludin · Aug 15, 2018

Slavister said:
Just wanted to say jaeger19 is wiping the floor on this thread. I don't know as much on this topic, but I do know some, and that is completely in line with what jaeger19 is saying.

When docs have financial motive to be more aggressive (or "defensive" if you like), not all but MANY will take it. jaeger19 quoted a couple studies confirming this too. You can't really blame them either. Same applies to most people in most other professions. They are humans. Many go into the profession for the money. Many had no or small income and only large debt until mid 30s with promise of making a ton afterwards. (The whole system IMO is setup with a bit of a wrong incentive.)

Ethics boards do have conflicts of interest, and as jaeger19 describes, most issues will never get there in the first place.

I will disagree with this one though - administrative costs of dealing with multiple insurance companies and many plans within each one are an unnecessary burden. Yes, private insurance companies are making money on this, but that's also the money that could be saved if we did not have the private insurance companies. This is one reason other countries have lower costs for healthcare. I know jaeger19 disagrees and states it's really only because they provide less services in other countries, but that's a discussion for another thread...

no he isn't. He defends system that over charges and price gouges people that need treatment. he defends procedures that cost half to 80% less than what they do if you pay cash.

This has been proven for a fact.

I have proven already in this thread why medical costs are so high. it is a combination of defensive medicine and administrative cost. that accounts for 60-80 cents out of every dollar.
there is a center in OK that does cash only services.

Their cost for a knee replacement? 15k dollars.
the average cost in the US for the same surgery?

The average hospital charge for a total knee replacement (TKR) in the United States is $49,500.

cost of a complete fracture? osts about $14,911
them? 6.3k.

he defends the cost of 40k dollar scans that cost 500.

pharmacies have the same issue the cash price for drugs is almost half the cost that the insurance company can give.
for supposedly getting the best price out there they suck at it.

my system eliminates all of that mess people are covered they don't need the government and we change how insurance works.

jaeger19 · Aug 16, 2018

ludin said:
we know you don't listen to facts.

Oh please... the only that doesn;t listen to facts is you. Heck.. Greenbeard and others have tried to explain the reality of healthcare to you.

Did you EVEN BOTHER... to look up what a prospective payment system is? and how hospitals are paid under it (usually a DRG tem).

You didn't did you?

Because if you HAD.. you would realize that for most things in the hospital under a DRG... the charge means nothing. The hospital gets paid the same for that diagnosis.. no matter what they charge.. and in fact.. the more tests, days in the hospital.. etc... THE LESS MONEY THE MAKE.

Why.. the heck do you think hospitals try kicking you out of the hospital as fast as they can.. when 40 years ago... you would stay 3 weeks for something that you stay 3 days for?

Whatever man... you want to believe what you want regardless of facts.

Have a good day.

jaeger19 · Aug 16, 2018

ludin said:
no he isn't. He defends system that over charges and price gouges people that need treatment. he defends procedures that cost half to 80% less than what they do if you pay cash.

This has been proven for a fact.

I have proven already in this thread why medical costs are so high. it is a combination of defensive medicine and administrative cost. that accounts for 60-80 cents out of every dollar.
there is a center in OK that does cash only services.

Their cost for a knee replacement? 15k dollars.
the average cost in the US for the same surgery?

The average hospital charge for a total knee replacement (TKR) in the United States is $49,500.

cost of a complete fracture? osts about $14,911
them? 6.3k.

he defends the cost of 40k dollar scans that cost 500.

pharmacies have the same issue the cash price for drugs is almost half the cost that the insurance company can give.
for supposedly getting the best price out there they suck at it.

my system eliminates all of that mess people are covered they don't need the government and we change how insurance works.

What a load of horsecrap..

NO ONE.. should take any of this as fact... since you demonstrate a complete lack of knowledge of the healthcare system.. or even how it gets paid.

Tell you what...

YOU please explain to everyone what prospective payment system is.. and what an example of that a DRG system is.. and how it fits in your "the hospital charges 40 for an MRI".

HERE IS YOUR CHANCE TO PROVE YOUR EXPERTISE...

Lets see it.