Eccentric Flower talk:200912/Cromwell Says

Jweader:

The whole "why are costs so high" question has such a complex answer that I really think it is un-answerable in whole. Medical service providers (i.e. doctors, hospitals) aren't the only ones who set rates. In fact, they're pretty far down on the list (right above patients). Insurance companies and the government are #1 and #2. Both can decide, seemingly on a whim, to change the entire basis of their pay structure. See this HHS release for some info.

Doctors, for the most part, have nothing to do with setting rates, since doctors are part of {1..n} practices / physician groups / etc. Those have relationships with hospitals, offices, etc. to give the docs somewhere to do their work.

I really have no idea how capital equipment gets purchased at each facility, and who all is involved in those decisions. I'm sure that there's a $400 hammer type of thing going on to spread out some of the capital costs, which is what leads to seemingly outrageous prices for what should be cheap(er) visits or procedures.

I have no doubt that much of the cost is in the complexity itself. And I think that's where the nationalized (or heavily regulated on a national scale) programs do much better, since the government can enforce a clearer relationship between the parties involved (or even limit the number of parties). Not gonna happen here, though. Any change will just make the system more complex, which in the end will make it more expensive overall.

-- 18:11, 17 December 2009 (GMT)

Joy:

I'm so disgusted with this whole thing that I'm just trying not to think about it too much. Yes, head in the sand, that's me.

I think it is absolutely, in this case, not better to do something rather than nothing. Because I fear that if something is done, then people (in govt mainly) will say they can move on to something else, that this got done and it is enough.

-- 18:12, 17 December 2009 (GMT)

Jweader:

See, and here is another part of the problem. Company focused on profit. Will force its product on health organizations, who then either have to eat (as overhead) the cost of any supplies that don't get used up, or coerce their patients into getting treatments they otherwise wouldn't have gotten (presumably because they don't need them).

-- 18:45, 17 December 2009 (GMT)

Columbina:

The idea that the cost-setting part is mostly in the hands of the people who don't, you know, actually give the health care is, to my mind, just another argument in favor of my point #2.

Which is not a disagreement.

-- 19:41, 17 December 2009 (GMT)

Andy:

The health care bill won't fix a lot of the things that are broken in the current system. But it's my understanding (unless this has changed; the bills change so much it's hard to keep track) will fix something that I think is very important; people will no longer be denied coverage on the basis of pre-existing conditions.

A good friend of mine spent the last 15 years of her life trapped in a miserable job, because her son had a brain tumor, and if she didn't keep that job, and the insurance that went with it, no-one else would insure her son (or her, during the last 5 of those years when she had breast cancer). And you can't blame the insurance companies for this: If one insurance company decided they would ignore pre-existing conditions, all the sick people would by insurance from them, and they could only survive by hiking rates to the point where no-one could afford the insurance. But if the governmnent requires *all* the insurance companies to insure regardless of pre-existing conditions, the adverse selection process goes away, and people are no longer trapped with the insurance they don't like and the jobs they don't like that go with it. Massachusetts has done things this way for years (this is not the recent MA mandated health-care law, but a much older one) and it's worked great. Unfortunately for Helen, she lived in NJ, not MA.

I think that fixing this is important enough that I haven't seen enough bad things in the health care bill to outweigh it. And it effects enough people that I think that if this passes, people will see that the sky-is-falling anti-health-care forces will lose credibility and get voted out of office, and something good can get enacted.

-- 21:05, 17 December 2009 (GMT)

Joy:

You know, that's true Andy. That is a huge problem with the current system, and fixing that alone is worth something.

-- 03:03, 18 December 2009 (GMT)