The (medical) cost conundrum: McAllen, TX

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Originally Posted by FuzzyLumpkins

If you give patients an itemized list including cost of procedures and include them in the decision making process ot that extent it would transfer a great deal more responsibility to the patient. That is the thing that annoys me, the manner that they charge creates an environment where they should be responsible yet they try and legislate away their liability.

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Totally agree.

But we again run up against the patient, especially in Medicare and Medicaid, who does not have any idea what they need. And then we find ourselves back to the age old problem of individual responsibility. It has always been assumed that the patient will not understand what tests they need. And requiring a doctor to explain it... Then they can't see massive number of patients they need for the million dollar mortgage and country club dues (Boutons rendition)

The government actually has made some cuts to tests some doctors think are necessary therefore they will not take patients in those programs, especially Medicaid, as they will not have any supplemental insurance.

This is a real mess. The boomers are old. The problem gets bigger.

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Originally Posted by boutons_deux

Buffoon, you assume every new test available is useful AND better than existing tests. Not the case, and is well known not to be the case with patented drugs (eg, generic metformin vs new patented replacements)

defensive medicine is part of the problem

but cost and revenue pressures dominate in FOR-PROFIT health care

some doctors have quit private practice to join clinics and hospitals, only to find mgmt considers them not to be doctors, but revenue centers will all the revenue pressure of private practice.

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I don't assume anything. I am telling you new tests come up that are better (give fewer false +) AND are more expensive.

Defensive medicine starts with the individual taking care of him or herself and taking care of their children. You read the number of Hispanics that are prone to diabetes and heart disease in the OP's article yet continue to consume processed sugar and saturated fats. I live in San Antonio, it's rampant here as well.

And the poor old folks that are constantly told by their physicians to stop a certain practice and they totally forget as no child is present to hear the instructions. I don't doubt some doctors are greedy and don't care, but others are continually frustrated by their patients.

When your average doctor's visit (note this has nothing to do with any testing or drugs, a mere office visit) costs 5x-17x what costs anywhere else in the world, and the standard of living difference is nowhere near as much, then something just doesn't add up.

One other thing I noticed when I moved to the US is how little time a doctor actually spends with a patient during such a visit. Most of the work is actually done by a PA or RN (if one is even available). Pretty similar situation with dentists.

That's not to say there are no exceptions to that, but that's my observation in general.

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Originally Posted by pgardn

What are the appropriate needs of each patient Dr. Buffoon? With more tests arising every week from medical technology which tests should and should not be run? Which are too expensive and way overdoing it and which are not?

Oh so you did NOT run this test, and now the patient needs a more expensive surgery... And you did not run the test because you thought it was excessive and expensive, so, you missed the diagnosis Dr. Buffoon.

But its easy for Dr. Boutons err.. Buffoon. Obviously there are clear cut cases, but there are many that are not. But it's all so black and white for the ideologue.

Boutons will write the protocol for each patient based on information from the patient and the past medical history from each patient. Because it's all so easy to get and so easy to decide exactly which tests to run. We await your AMA manual Dr. Boutons.

And this is only one problem...

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I'm with you on this one, mostly.

Doctors are caught in a pinch, but I can tell you first hand from experience that doctor practices seem to me at least to be set up to milk the maximum revenue out of a patient for the least effort on the part of the doctor.

I love my doctor, who is a wonderful, kind, and smart woman, but the business model of the practice she is stuck in... sucks monkey balls.

We need to heavily subsidize med school, and pay doctors a fairly generous salary. Fee for service seems too likely to distort things, regardless of whether it does in reality. Even if you only reduce the appearance of impropriety, that is reason enough to change the system, IMO.

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Originally Posted by RandomGuy

I'm with you on this one, mostly.

Doctors are caught in a pinch, but I can tell you first hand from experience that doctor practices seem to me at least to be set up to milk the maximum revenue out of a patient for the least effort on the part of the doctor.

I love my doctor, who is a wonderful, kind, and smart woman, but the business model of the practice she is stuck in... sucks monkey balls.

We need to heavily subsidize med school, and pay doctors a fairly generous salary. Fee for service seems too likely to distort things, regardless of whether it does in reality. Even if you only reduce the appearance of impropriety, that is reason enough to change the system, IMO.

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Perfectly reasonable.

I personally think its a good thing we are seeing more women doctors. My doctor is male and very good at explaining why he is doing certain tests and very good with the studies as well. But I ask questions that indicate I know the stuff. He gets a chance to show off his knowledge. He sees way too many patients imo.

What happens to the people who are not proactive with their yearly checkup? What happens to the poor folks with a chronic problem that are not proactive because they just don't understand enough to ask good questions? They, and or their insurance, keeps getting milked. And I am sure my own doctor is good at rationalizing the large number of patients he sees everyday, just like in the OP's article.

I think a huge step forward would be requiring a health class everyday in elementary school. A health class in middle school. And a much more rigorous health class in high school where all the major body systems are studied for a full year. And we require a biology teacher, not a coach, to teach it.

People must know more about their own body. Some people treat their body like a car, let the mechanic handle it. On the other hand there are quite a few males who know how a car works better than how they work.

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Originally Posted by ElNono

When your average doctor's visit (note this has nothing to do with any testing or drugs, a mere office visit) costs 5x-17x what costs anywhere else in the world, and the standard of living difference is nowhere near as much, then something just doesn't add up.

One other thing I noticed when I moved to the US is how little time a doctor actually spends with a patient during such a visit. Most of the work is actually done by a PA or RN (if one is even available). Pretty similar situation with dentists.

That's not to say there are no exceptions to that, but that's my observation in general.

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Well, if you want lowered costs, we need serious tort reform.

Let's take the example in post #44. I'll bet that the only reason Canada can sell them for less if that the agreement to sell at the lower price included that no lawsuits can come to haunt them. We are a sue crazy society. Drug manufacturers calculate a given percentage of the profits as going to pay for such litigation, hence the wholesale cost is higher here as well. I would be OK with people buying their drugs from Canada if at the same time, they sign away any right to sue the drug manufacturer.

:lol tort reform

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Originally Posted by Trainwreck2100

:lol tort reform

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"that no lawsuits can come to haunt them."

Canadians get killed and maimed and compensated for the same untested toxic drugs that kill and maim Americans.

US drug mfrs spend twice as much marketing as they do on research and testing. New drugs, FDA accepting the drug mfrs own testing (negative results suppressed), are basically beta or alpha tested on unknowing, trusting patients.

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Originally Posted by Wild Cobra

Well, if you want lowered costs, we need serious tort reform.

Let's take the example in post #44. I'll bet that the only reason Canada can sell them for less if that the agreement to sell at the lower price included that no lawsuits can come to haunt them. We are a sue crazy society. Drug manufacturers calculate a given percentage of the profits as going to pay for such litigation, hence the wholesale cost is higher here as well. I would be OK with people buying their drugs from Canada if at the same time, they sign away any right to sue the drug manufacturer.

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LOL tort reform.

Small part of a very large, complicated machine.

http://heartland.org/sites/all/modul...pdfs/20309.pdf

If you really want to get a better sense, start parusing the white papers on what drives the costs. it takes some sifting and everybody has their pet interests, but you are vastly oversimplifying the issue.

http://www.spurstalk.com/forums/show...ht=tort+reform

the OP was based on Medicare stats, a new study reveals what's happening with thye privately insured:

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Differences in the number of tests and treatments given from place to place are still huge for the privately insured. But the cost of health care is like the cost of groceries—the total depends on the price of every item and on how many items you get. Both Medicare and private insurers have adopted policies and reforms that are reducing unnecessary tests and treatments and improving preventive care. In McAllen, as I wrote in May, such changes have saved Medicare an estimated half-billion dollars for that one community alone. But cutting costs for privately insured patients also requires addressing prices. And that’s a different matter entirely.


When your grocery store is the only one in town, it can jack up prices without losing customers. The same goes for hospitals. The study found that hospital prices in monopoly markets are fifteen per cent higher than in those with four or more hospitals.


It’s the Cost Conundrum Squared. The bigger the hospital, the more it can adopt systems that deliver better-organized, higher-quality, less-wasteful care. But the bigger the hospital, the more power it has to raise prices.

We have a few ways out of the conundrum. We can regulate the prices hospitals charge insurers—this is what Maryland does. We can break up big hospitals. We can encourage hospitals to become the insurers. (That’s what Kaiser Permanente in California has done. It provides members with prepaid care at its hospitals and clinics.) Or we can expand Medicare to more and more people until we’re single payer.

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http://www.newyorker.com/news/news-d...undrum-squared

"We can regulate the prices hospitals charge insurers"

no, can't do that. the (mythical) unfettered free market and competition always deliver the optimal solution (for BigCorp)

"We can break up big hospitals"

the opposite is happening. Hospitals are buying up hospitals, clinics, hiring independent doctors who are pressured by financial managers to deliver revenue, not care.

Kaiser is a historical artefact, a non-profit that is extremely profitable.

expand medicare? Repugs block expanding medicaid.

single payer? ain't NEVER gonna happen, has been and will be blocked by the unstoppably powerful BigInsurer, BigMedicine, BigPharma.

if people who believe otherwise take their marbles and go home, they cede the political field to those trying to screw them.

is that what you want?

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Originally Posted by Winehole23

if people who believe otherwise take their marbles and go home, they cede the political field to those trying to screw them.

is that what you want?

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Whine Hole, it's already marbles GAMEOVER. Human-Americans, patients, customers, employees LOST BIG.

I'd love to hear your path from where we are fucked up now to the airy-fairyland at the end of that article.

I have family in the area (10 miles away from McAllen, TX actually), and the amount of piss poor service and corruption in the health services segment is repugnant. Places like Retama Manor in Weslaco (at least up until a couple years ago) were only interested in the govt checks, treated patients extremely poorly, had illegals with little to no medical training looking after patients and an amazing turnover rate for employees (not to mention having things stolen from patients' rooms all the time, or when two employees were busted for having sex in one of the rooms).

Another fairly common occurrence around here is 'agencies' that 'hire' somebody in your family to do home care for you, paying them dimes while billing Medicare/Medicaid for the 'service' and pocketing most of it. My father in law (disabled) actually did not want to be part of that and couldn't get the 'agency' to stop calling him.

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Originally Posted by ElNono

I have family in the area (10 miles away from McAllen, TX actually)

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But what does Reynosa have to do with health care in the US tbh?

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Originally Posted by baseline bum

But what does Reynosa have to do with health care in the US tbh?

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:lol I was actually in Las Flores (Mejico) for the first time ever two days ago... chock full of winter Texans

Reminded me a lot of Argentina

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Originally Posted by boutons_deux

Whine Hole, it's already marbles GAMEOVER. Human-Americans, patients, customers, employees LOST BIG.

I'd love to hear your path from where we are fucked up now to the airy-fairyland at the end of that article.

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you think we should all give up, go home and suck our thumbs?

you're the fucking apologist. you think the game is over. you'd cede the field to the motherfuckers without a fight.

you're wrong.

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Originally Posted by Winehole23

you're the fucking apologist. you think the game is over. you'd cede the field to the motherfuckers without a fight.

you're wrong.

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it's (has been) GAMEOVER, Whine Hole.

fight?

I'm still waiting for your PRACTICAL path to (winning) the battle with the BigCorp and 1%.

What steps do we take to stop the looting of Human-Americans by the 1%, by BigCorp, BigFinance, BigHealthcare?

and of course the "steps" must include electing an unblockable "socialist" majority (aka For The People) in Congress.

Gerrymandering, voter suppression, the VRWC/1%/Repug SCOTUS' "C-U $Bs in politics" have DISENFRANCHISED Human-Americans.

Even the duped tea baggers and duped cosplay patriot "marans" are pissed that THEIR (1%-financed) Repugs can't, won't do shit for them, other than protect/enrich the 1% and BigCorp.

Where do we assemble for the fight, Oh Great Fighter?

Aren't you worried about the militarized, police/surveillance state, which already snoops on anti-war dissenters, like nuns.

Those NSA/FBI/CIA/der-heimat-security Madame Defarges have knitted your name and "thoughts" into their wooly databases, ready to pounce.

We can't even raise the minimum wage to $15 or $20 to lift 10Ms of We The People out of poverty in The Greatest, Wealthiest, God-preferred Country Ever In The Universe.

America, after the anomaly of 1945 - 1975, has regressed to the historical mean of an oligarchy, the country owned, operated, ruled by a few wealthy people who will NEVER, have NEVER yielded power without your "fight".

Where do we assemble?

<a href="https://www.facebook.com/RepresentUs/videos/1175706399109896/" target="_blank" rel="nofollow">

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We can't even raise the minimum wage to $15 or $20

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many cities have done it already, without the permission of the oligarchs. how could that possibly have happened in a wholly owned subsidiary like the USA?

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Originally Posted by Winehole23

many cities have done it already, without the permission of the oligarchs. how could that possibly have happened in a wholly owned subsidiary like the USA?

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nope, only a couple.

Most as of 1 Jan don't go above $10, or $20K/year for 2000 hours, still deeply in poverty,needing taxpayer subsidy to poverty-wage businesses.

$15 or $20 has be a FEDERAL minimum so cities, regions that pay more don't get screwed by slave, red states that pay $7.25. And Federal minimum has to be adjusted for cost-of-living by metro region.