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When I had a Baker's Cyst 3-4 years ago, first came the Ultrasound, then the X-ray's, then the MRI, then the call for an MRI with Contrast. But the insurance company and my deductibles are paying for it. So when Mr. Orthopedist insisted upon the MRI with Contrast I raced down to Angeles Hospital in Tijuana. I showed him the images and he laughed in my face. "For a Baker's Cyst, I rarely even call for an X-ray!" All it needed was aspiration. $300, I paid it happily.
I have had two similar experiences:
Clouds in my Eyes -
In 1995 I had some clouds in my right, weak eye. I had a standard eye exam, which was clean. Then a flourescine angiography (sp on both) which was clean. Then they wanted an MRI. I agreed. It was "boringly normal." Then they wanted a baseline neurological. I asked if this was to test for MS, the doctor said "yes." I asked if the way I spent the next day would change based on the results, and he said "no." I got out of the chair, told him to "jump in a lake" and walked out. 25 years later I am fine. The clouds resolved over a period of about ten years. I think I had burst a blood vessel carrying litigation documents.
TIA
On October 31, 2017 I was home from work on a personal engagement but was doing some work from home While I was preparing a chart on the computer and was typing on the keyboard and had trouble with getting my right hand to work correctly. I typed out the last digits on the chart one-handed and then took an hour nap. At that point I little better. I went to sleep after Halloween visitors stopped coming.
The next day at work I was slurring my words and had trouble typing. November 1 was the worst day. On November 2, I went to theater in NYC with my wife and felt almost normal. The next few weeks were a bit “on and off.” When I played tennis on Wednesday, November 15, one of the other players still noticed a slight limp. I was roundly criticized for not going to a doctor. Finally, in early February 2018 I started taking 32 mgs. of aspirin daily, and am back to 100%, except for some muscle atrophy that took its time to resolve.
Not bad for self-diagnosis and self-medication, which, for most ailments, I do not recommend. Symptoms and treatments for my situation, however, are well-known.
Summary - Our system is biased towards over-diagnosis and over-treatment. This would not likely happen if doctors had to think about satisfying a paying customer.
You hear of Doctors saying that the extra imaging protects them from malpractice suits. What do you think? Just an excuse? And why aren't the insurance companies cracking down on all this out of control imaging?
You are making my point for me. They wouldn't cost upwards of $10,000 per month if the actual customers had to pay. The cost gets out of hand when a third-party payer indifferent to cost is "paying", or acting as a conduit of yet someone else's money.
It would cost less than $10,000, but you shouldn't make the mistake of thinking everyone could afford it either.
There are fixed costs that must be incurred in virtually any occupation or profession furnishing services to the public. If an injured person comes to visit a doctor, he is going to have to have a room to exam that patient and an examination table. He will have to have an x-ray machine to get images of the part that was injured. Someone will have to read the x-rays, a radiologist. The doctor will have to take a history and conduct an examination. These things take time. What a doctor has to sell when it comes right down to it is his time.
The reality is that good medical care simply costs money. Some people do not earn enough to pay for it because their wages are much less than what a doctor earns or would earn under a system even without insurance.
I have said before the real reason health insurance exists is that when medical treatment was provided on a cash basis in the past it was reaching a point where many could not afford it. Its why the best employers chose to offer it. They saw it as a benefit that employees would appreciate.
The market can't solve all our problems. If it could there would not be a need for government. The market cannot solve the problem of people with low wages being unable to afford health care. What would happen without insurance is that the medical field would likely not serve them at all. Instead, all resources would be focused on those who could pay and methods would be found to be get them to pay more because greater profits could be earned this way.
Why does no first world country in the world follow this approach? Why do they all rely on some kind of national health care (Britain), universal private health insurance (Germany, Switzerland), or national health insurance? (Canada) The failure of any nation to adopt the type of system you describe speaks volumes.
Believe what you wish. But my sources state otherwise. And common sense would lead one to expect HIGHER COSTS for any physician compelled to hire staffing to deal with insurance paperwork. I can recall when a typical doctor's office had one staff member - a nurse - often his wife - and nothing to fill out. I can recall some offices with NO nurse - just the doctor. $10 office visit, too.
Malpractice is not just premium costs but the pressure to practice "Defensive" medicine.
They asked doctors how much they thought was spent on defensive medicine and these doctors guessed that it was about $650-$850 billion a year! Their breakdown of costly and unnecessary orders included unnecessary surgeries, diagnostic tests, hospitalizations and prescriptions.
Blue Cross and Blue Shield are health insurance providers so they actually do pay for some of this defensive medicine. They estimate that defensive medicine costs about $45.6 billion a year, which is still a lot of money, but only a small fraction of the amount doctors guessed that it cost.
. . .
Eliminating all insurance, government meddling, and tort reform would reduce the cost to buy healthcare. Of course that will not affect the influence of a debauched money system that has systematically gutted the buying power of the circulating medium since 1914.
This is a huge part of the problem. Why do they have to have two or three nurses in the room every time a nurse picks up a baby? the extra nurses are not doing anything but watching so they can give the professional opinion that the nurse actually doing something did it correctly - just in case something happens.
Yes it is conceptually a good idea to have extra nurses checking to make certain the acting nurse does not mess up. Sure it is a good idea to do every known test and get 9 second opinions from doctors just to be safe. great idea - if you have unlimited resources. However when you have people unable to get treatment because too many people are tied up with "just to be safe" then the concept no longer makes any sense.
Insurance premiums are just a tiny faction of the added cost from liability paranoia. Every level of anything provided to or through a hospital of doctors office includes layer upon layer of not only liability insurances premiums, but excessive safety precautions. The band aid company may now have three people inspect the band aid, packaging etc for cleanliness, but they lawyer will ask the jury "whay didn't they have five inspections? It would not cost them that much, and look how much profit the company makes.." Then when they have five, the next lawyer will say why not seven? If they cannot get at the band aid company, then they go after the packaging company until the packaging company has an excessive amount of safety and QC/QC processes and costs, then they go after the gauze maker, then the middle man - why did he not have it inspected or sanitized before passing it on to the hospital? , then the next person in the chain . . . Pretty soon a band-aid provided by a hospital or doctor costs $50 even though you can get one for about 7 cents at CVS.
This is just on example of one product (slightly exaggerated) to demonstrate the underlying problems. It impacts absolutely everything a hospital does or offers. Look around your doctor's office. Everything in there costs 10 to 50o times what is should mostly because of liability paranoia.
The point is that if insurance weren't involved the bills wouldn't be ridiculous. I don't know what it takes people to understand the impact of a third-party payer who is, short term, indifferent to the amount of the bills, and why that wouldn't drive them sky-high.
There is a cost to manage the distribution of medical services regardless of whether that management is done by the Government or by private insurance companies. The cost of managing the distribution and payment for medical costs does not magically go away if the government does it instead of a private insurance company. The question is which of them will manage it more effectively and more efficiently. Government has a very poor history of cost control management. ($800 hammer anyone?). I am not sure private insurance companies do that much better, but the cost is there regardless. I am not sure whether it makes any difference if it is insurance company shareholders or politicians who are getting rich off of it. However for some reason, it seems many people are more willing to accept politicians becoming millionaires or billionaires than private investors.
There is a cost to manage the distribution of medical services regardless of whether that management is done by the Government or by private insurance companies. The cost of managing the distribution and payment for medical costs does not magically go away if the government does it instead of a private insurance company. The question is which of them will manage it more effectively and more efficiently. Government has a very poor history of cost control management. ($800 hammer anyone?). I am not sure private insurance companies do that much better, but the cost is there regardless. I am not sure whether it makes any difference if it is insurance company shareholders or politicians who are getting rich off of it. However for some reason, it seems many people are more willing to accept politicians becoming millionaires or billionaires than private investors.
Those apparent excesses in spending (actually, accounting errors) were on the part of the U.S. Department of Defense, which appeared to have became reckless with our tax-payer dollars following President Ronald Reagan's expansion of their budget back in the 1980s. To Reagan's credit, he corrected the DOD's procedures by creating the Packard Commission.
The reality is that, today, there are more watchdog agencies (governmental, media-based, and private) keeping an eye on how our taxpayer dollars are being spent than there were in the past. And there is certainly greater demand for government accountability.
There is a cost to manage the distribution of medical services regardless of whether that management is done by the Government or by private insurance companies. The cost of managing the distribution and payment for medical costs does not magically go away if the government does it instead of a private insurance company. The question is which of them will manage it more effectively and more efficiently. Government has a very poor history of cost control management. ($800 hammer anyone?). I am not sure private insurance companies do that much better, but the cost is there regardless. I am not sure whether it makes any difference if it is insurance company shareholders or politicians who are getting rich off of it. However for some reason, it seems many people are more willing to accept politicians becoming millionaires or billionaires than private investors.
Here's my point, which I might not have written out very well. Let's say I go to a restaurant and have an uncapped expense account. I will order the lobster entree rather than an almost as delicious shrimp, since I do not care about price.
the impact of insurance is to make the patient unconcerned about price.
Where we retired, there is UHC, and also a private system, reasonably priced. We discovered ---along with other expats---that the HC system is best suited for catastrophic. We use a private clinic for every day stuff because it is so cheap. $30 to see a specialist, $50 for an ultra-sound and so forth.
But I had 3 emergencies with ambulances and I was sure glad to have that UHC as this would have bankrupted me in the U.S., even WITH insurance, due to copays and deductibles we don't have here. I had 3 5-day stays and not a penny out of my pocket.
The poor people here can access the public system for free, which of course crowds the medical centers so we pay for private clinics unless it's an emergency.
Also have house-call doctors for cheap too.
It keeps our monthly premiums under $100 for us both.
Admittedly an "out of the box" thought inspired by this other thread (link).
I have a radical idea that I entertain occasionally. Back in the day, before insurance was prevalent, medical service administration and bills were far lower. Basically you walked into an office, sat down in the waiting room and the doctor came out when he was ready to see you. My pediatrician bill, in 1963 was around $6. So even adjusting for inflation (and prices have not gone up six-fold) that would be $36 or less. As for reaching the doctor you would call and he would return calls between 5PM and 7PM except for emergencies.
Adult matters may be a bit more complex. However, I can't believe that the armies of paper-pushers are free, or needed. I wonder if we'd be better off eliminating employer-paid insurance, and perhaps recasting Medicare as insurance, for all people, against true catastrophes, such as complex cancer or heart disease, or muscular dystrophy. Much of the GDP is now going towards "health care" or more likely overhead. Insurance also distorts employment relationships. Since employer-paid premiums are deductible and the employees' share is paid in pre-tax dollars, too much money is allocated to insurance.
The net result of this is that no one is satisfied. Doctors are unhappy and not doing well. Patients are often stuck in "voice mail jail" dealing with insurers or medical care groups. And life spans have been expanded well beyond the ability of many people to work. Even if I can continue working (I'm a lawyer) can a pipe-fitter who goes into sewers or construction workers who go onto scaffolding often work into their 80's? Maybe some can. But not many. All and all I think we'd be better off with far less insurance.
IMHO, Insurance coverage of medical issues should be limited to catastrophic matters. Get cancer, insurance coveres it. Need a bypass, insurance covers it. Net your varicose veins injected, on you.
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