Average Miami family pays $20,000 in health costs (taxes, fence)

[vdy1985]

Originally Posted by BCreass

I agree with most of this, apart from the "bolded" part. "don't want to pay the bill" is a common misconception -- what about "can't pay the bill"? Without insurance, even a doctor's visit is out of reach to most. I have nothing but sympathy for these people, especially those who have found themselves unemployed as a result of this particularly bad recession.

Very true. Of course if somebody is suffering an acute heart attack, they should be treated immediately with no questions asked about $. The problem then lies with the fact that the hospital cannot recoupe any payment, which is why they jack up the bill more for insured patients.

Those with medicaid will go to the ER, because the payout of medicaid to see the doctor is so little that it isn't worth the doctors risk/benifit ratio. The risk is seeing the patient, and potentially being exposed to litigation, but the benefit is to get paid. But medicaid is such a poor payer that the ratio is not worth it to see the medicaid patient. Hence the medicaid patient goes to the ER for minor complaints, ie. ear infections. Medicaid does not pay the hospital as well as private insurance. The whole billing system is nuts and very complicated.

[vpcats]

Originally Posted by vdy1985

More food for thought:

Britain has only one-fourth as many CT scanners per capita as the U.S., and one-third as many MRI scanners. The rate at which the British provide coronary-bypass surgery or angioplasty to heart patients is only one-fourth the U.S. rate, and hip replacements are only two-thirds the U.S. rate. The rate for treating kidney failure (dialysis or transplant) is five times higher in the U.S. for patients between the ages of 45 and 84, and nine times higher for patients 85 years or older.

Overall, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. In 2002–2004, dialysis patients waited an average of 16 days for permanent blood-vessel access in the U.S., 20 days in Europe, and 62 days in Canada. In 2000, Norwegian patients waited an average of 133 days for hip replacement, 63 days for cataract surgery, 160 days for a knee replacement, and 46 days for bypass surgery after being approved for treatment. Short waits for cataract surgery produce better outcomes, prompt coronary-artery bypass reduces mortality, and rapid hip replacement reduces disability and death. Studies show that only 5 percent of Americans wait more than four months for surgery, compared with 23 percent of Australians, 26 percent of New Zealanders, 27 percent of Canadians, and 36 percent of Britons.

We are used to instant gratification here. Everything is available and accessible. You get what you need and what you don't need, and then you lose your home because you can't pay for unnecessary tests to rule out pulmonary embolism because you went to the doctor for dizziness.

We may not have as long of a waiting period for some procedures, but are these urgent anyway? Will it make a whole lot of difference if it takes another week? Cataract surgery is surely not an emergent procedure, unless you might have a retinal detachment but they can't see the back of your eye because of the dense cataract that didn't bother you before.

Of course, some things are a matter of life or death but think about it, HMOs have made it their business and therefore their bottom line, to delay authorizations, to delay payments, and to deny payment so you have to go through the appeals process before you get paid. It's called stalling and it's agains Florida statutes but it happens.

Our system is no better than anywhere else. It's just a big burden to all - patients and physicians alike.

[EnjoyTheSilence]

Originally Posted by vdy1985

Very true. Of course if somebody is suffering an acute heart attack, they should be treated immediately with no questions asked about $. The problem then lies with the fact that the hospital cannot recoupe any payment, which is why they jack up the bill more for insured patients.

Those with medicaid will go to the ER, because the payout of medicaid to see the doctor is so little that it isn't worth the doctors risk/benifit ratio. The risk is seeing the patient, and potentially being exposed to litigation, but the benefit is to get paid. But medicaid is such a poor payer that the ratio is not worth it to see the medicaid patient. Hence the medicaid patient goes to the ER for minor complaints, ie. ear infections. Medicaid does not pay the hospital as well as private insurance. The whole billing system is nuts and very complicated.

I think we may all agree that major reform is needed as there's just far too much bureaucracy and red tape, which is literally costing us all billions of dollars. In the long run, socialized medicine would probably be cheaper for all of us, but that may not happen here in the United States, despite the fact that I'd probably be in favor of it, to a certain extent. However, the British system is a bad example -- although I'm sure that if you polled people there, most would not want to swap their NHS for a "for profit" system like the one we have in the United States. Different strokes for different folks, or something like that.

[vpcats]

Originally Posted by vdy1985

Again, about the PA, NP issue, sure you may know some outliers. But the average PA is is making 80K, and the average NP is making maybe a little more or about the same. Google it.

And the Family Doctor, unless you are working for the military overseas or an extermely rural community, you will NOT get hospital privalidges nor will you get malpractice insurance if you are not Board Certifed (this requires doing a residency, which for Family practice is 3 years).

Yes Family Practice is a specialty and requires certification. GP does not. I used "family" in the old way it used to be referred to - family doctor, not Family Medicine.

[vdy1985]

Ultimately there are going to have to be some ethical considerations. A lot of costs are in treatment to the elderly. They get the most procedures done to them, yet can continue to have a poor quality of life... but hey, they are alive so it is worth it.... or is it? Medince is very capable of extending life for a looong time, however quality of life isn't always there, but the costs are.

What do we do about this, I can't say.

[EnjoyTheSilence]

Originally Posted by vpcats

We are used to instant gratification here. Everything is available and accessible. You get what you need and what you don't need, and then you lose your home because you can't pay for unnecessary tests to rule out pulmonary embolism because you went to the doctor for dizziness.

We may not have as long of a waiting period for some procedures, but are these urgent anyway? Will it make a whole lot of difference if it takes another week? Cataract surgery is surely not an emergent procedure, unless you might have a retinal detachment but they can't see the back of your eye because of the dense cataract that didn't bother you before.

Of course, some things are a matter of life or death but think about it, HMOs have made it their business and therefore their bottom line, to delay authorizations, to delay payments, and to deny payment so you have to go through the appeals process before you get paid. It's called stalling and it's agains Florida statutes but it happens.

Our system is no better than anywhere else. It's just a big burden to all - patients and physicians alike.

I'm sure that doctors here are literally forced to employ extra admin staff, just to cope with the monstrous amount of paperwork generated by having to deal with multiple insurance companies, each with their own set of rules and regulations.

It's baffling.

[vpcats]

Originally Posted by vdy1985

Very true. Of course if somebody is suffering an acute heart attack, they should be treated immediately with no questions asked about $. The problem then lies with the fact that the hospital cannot recoupe any payment, which is why they jack up the bill more for insured patients.

Those with medicaid will go to the ER, because the payout of medicaid to see the doctor is so little that it isn't worth the doctors risk/benifit ratio. The risk is seeing the patient, and potentially being exposed to litigation, but the benefit is to get paid. But medicaid is such a poor payer that the ratio is not worth it to see the medicaid patient. Hence the medicaid patient goes to the ER for minor complaints, ie. ear infections. Medicaid does not pay the hospital as well as private insurance. The whole billing system is nuts and very complicated.

Medicaid does pay the hospital very well. Not the physician. Private insurance pays a percentage of charges for the most part. That's why charges are so jacked up.
The hospital recoups their money even from non-paying patients by reporting the bad debt on their cost report. But it's true that the insured and self-pay subsidize the non-insured to a large extent.

[vdy1985]

Originally Posted by vpcats

Yes Family Practice is a specialty and requires certification. GP does not. I used "family" in the old way it used to be referred to - family doctor, not Family Medicine.

I understand. I'm just saying you'd be hard pressed to find a GP outside of the military.

[vdy1985]

Originally Posted by vpcats

We are used to instant gratification here. Everything is available and accessible. You get what you need and what you don't need, and then you lose your home because you can't pay for unnecessary tests to rule out pulmonary embolism because you went to the doctor for dizziness.

We may not have as long of a waiting period for some procedures, but are these urgent anyway? Will it make a whole lot of difference if it takes another week? Cataract surgery is surely not an emergent procedure, unless you might have a retinal detachment but they can't see the back of your eye because of the dense cataract that didn't bother you before.

Of course, some things are a matter of life or death but think about it, HMOs have made it their business and therefore their bottom line, to delay authorizations, to delay payments, and to deny payment so you have to go through the appeals process before you get paid. It's called stalling and it's agains Florida statutes but it happens.

Our system is no better than anywhere else. It's just a big burden to all - patients and physicians alike.

Valid points.

Let's put it this way, if you injured your knee and were on crutches, you wouldn't want to wait 3 months before your operation so you can get your life back to normal. Can you wait, yes, but most don't want to wait that long to start getting there life back to normal. I've been there, and had to wait 2 weeks for my surgery, couldn't imagine 3 months.

[vpcats]

Prevention is the key.
Was it BCreass who said something about preventive medicine? But we have to change our thinking, our expectations, our notion of entitlement. We have to start from scratch. Go back to the old ways before cars, remote controls, washing machines, lolll....well, maybe not that far back.
The mentality has to change. The "easy" button has to disappear.

I hate to use the term "brainwash" but I think we need to work on it because people have to wake up. We are running ourselves into the dirt so technology doesn't matter, board certified genius diagnosticians won't matter if we don't start to make some changes across the board.