(no subject)
Aug. 21st, 2012 10:55 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
liliaethIt's weird,but I'm always shocked to hear about the costs of healthcare in the US. Can doctors, and especially specialists really demand fees that high?
Just thinking, even without the Ziekenfonds here, I'd still barely pay 30€ for a visit to my GP. And a visit to a specialist costed me about the same, in preparation to my operation. With aid from the Ziekenfonds that amount can usually be cut in two if not more. The same goes for dentists.
Or when I hear about vet visits for pets that cost over a 1000. Now my Dru's only had one bit of surgery, aka her sterilisation. But even with that included, I don't think I've spent more than 200€ on all of her vet visits and care in all the years I've had the joy of her companionship.
I mean I've got a hospitalisation insurrance, but honestly, that's more for paying stuff like hospital rooms and post-hospital care, than to pay the doctors. And I don't think that I pay more than a 100€ a year on my Ziekenfonds either.
That aside, my stupid main comp refuses to start up since saturday. I have no idea what's wrong, everything was ok on friday when I pulled out the plug cause I was staying over at my mom's place, and now it utterly refuses to work. If I was actually able to bend over as I should, I'd pull out all unnecessery plugs and try again that way, but... just glad I recently bought this netbook or I wouldn't be able to go online at all.
Just thinking, even without the Ziekenfonds here, I'd still barely pay 30€ for a visit to my GP. And a visit to a specialist costed me about the same, in preparation to my operation. With aid from the Ziekenfonds that amount can usually be cut in two if not more. The same goes for dentists.
Or when I hear about vet visits for pets that cost over a 1000. Now my Dru's only had one bit of surgery, aka her sterilisation. But even with that included, I don't think I've spent more than 200€ on all of her vet visits and care in all the years I've had the joy of her companionship.
I mean I've got a hospitalisation insurrance, but honestly, that's more for paying stuff like hospital rooms and post-hospital care, than to pay the doctors. And I don't think that I pay more than a 100€ a year on my Ziekenfonds either.
That aside, my stupid main comp refuses to start up since saturday. I have no idea what's wrong, everything was ok on friday when I pulled out the plug cause I was staying over at my mom's place, and now it utterly refuses to work. If I was actually able to bend over as I should, I'd pull out all unnecessery plugs and try again that way, but... just glad I recently bought this netbook or I wouldn't be able to go online at all.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
Date: 2012-08-21 11:27 am (UTC)Absolutely and the insurance companies shell out to them without blinking. Which is why if you don't have insurance, you're pretty much screwed.
And indeed dentists and vets bills are equally high over here so you're lucky if you have dental insurance coverage.
no subject
Date: 2012-08-21 11:59 am (UTC)In other words, it's 6000 kinds of screwed all to hell. And some ignorant people act like it's just amazing and wonderful and any attempt at public health care is the devil. Don't ask me why.Stupidity breeds stupidity.
no subject
Date: 2012-08-21 12:29 pm (UTC)Vet visits on the other hand are not and are very expensive. I have pet insurance on my dogs. I get 80% back on all medication and procedures etc (after my premium is paid).
no subject
Date: 2012-08-21 01:36 pm (UTC)It sucks, plain and simple.
no subject
Date: 2012-08-21 02:07 pm (UTC)Anyway, I guess that explains why I haven't 'seen' you online for a couple of days. No YIM. Miss you, love. Just glad to know you're okay. Hurry back!
no subject
Date: 2012-08-21 03:53 pm (UTC)In a word -- yes.
It basically works like this.
Medicare is (at least currently) available for seniors. Medicare sets what rate they can charge for seniors. Basically, they reimburse doctors X for procedure X. Set fee. Private insurance that a senior may have will also kick in a nominal amount (leaving the vast majority to medicate to pay because...well... they can) but with insurance companies it's another issue.
Doctors/Hospitals bill X for a procedure X, however Insurance Companies negotiate with Hospitals what they're willing to pay, which is Y. So what is listed on the bill is usually not what is paid... if it's paid by insurance (though you do have to pay your deductible before insurance will kick in. What your deductible is varies based on how good of insurance you have... which is usually up to your employer).
So essentially, different insurance companies are different, reduced rate Y based that they've negotiated for procedure X.
If you don't have insurance, well tough luck. You're paying full price not the insurance company's reduced rate.
Not that everyone has the same insurance anyway. How much you're responsible for out of pocket, your lifetime cap of possible benefits, etc is set by what your individual insurance will cover (though Obamacare eliminates the "lifetime cap"... which is one of the reasons the insurance companies are spending millions trying to have Obamacare repealed).
Really big corporations get a better selection of insurance policies (because it's spreading the risk over a larger population) than small businesses or -- God forbid -- an individual. So how much you pay for insurance and how much insurance will pay your doctor is based on a number of factors including the size of the business where you are employed, what kind of benefits your job offers, and how much they're willing to spend on premiums.
Buying insurance as an individual? You really want to avoid that if you can. It's exhorbitant.
That's of course if you can buy insurance, because if you've been sick in the past and have lost insurance they can simply not accept you based on a 'pre-existing condition' or they can refuse payment on something if they can categorize it as a 'pre-existing condition.'
Of course that means there's a sick population without insurance, and ethically many hospitals are compelled to treat the insuranceless, who if they can't pay...well... the hospital jacks up the prices on those with insurance (See the vicious cycle?)
And just to make it all just a bit more gag-worthy, something like 80% of the states amount to what is essentially an insurance monopoly as insurance companies don't want to directly compete with one another (that whole capitalistic competition thing isn't desirable to them) so in most states there's essentially a monopoly on which insurance company is predominately available. So it's not like it's particularly easy to shop around for a better insurance company or lower premiums. In my state in excess of 90% of the population is the same insurance company.
So... yeah... our system makes no damn sense.
no subject
Date: 2012-08-21 03:59 pm (UTC)no subject
Date: 2012-08-21 04:35 pm (UTC)no subject
Date: 2012-08-21 06:28 pm (UTC)I sort of agree with Caesar Milan's concept of making savings account for 'pet healtcare'.
no subject
Date: 2012-08-25 04:49 pm (UTC)The US healthcare system is a turducken of self-reinforcing bad design. In my below estimates I'm going to assume doctors work 200 days per year (365 - 104 weekends - bank holidays, - leave, - conferences - illness). It's slightly low - but this is all back of the envelope estimates.
Doctor Costs are more expensive
Lack of free healthcare does horrible things to the insurance rates.
When something goes wrong medically then in a sane system the damages paid would cover the direct damages inflicted. Future operations would be covered by the state - and many people don't bother to sue. In the US, there is no safety net to treat patients, therefore patients need to sue as otherwise they have no future healthcare - and the damages they are suing to cover aren't just for direct damages, but for all future healthcare to cover those damages. There's therefore a very good reason Americans are more likely to sue. What this does to doctors' malpractice insurance rates I leave to your imagination, but last time I checked (a few years ago now - so these numbers will be low), the overheads to just insure the doctor against being sued ranged from $30,000/year to $150,000/year (this latter value for an obstetrician). So to employ one single doctor takes that much extra in overheads before lighting, salary, support staff, etc. As european malpractice insurance rates are comparatively trivial, that's several hundred dollars income every single American doctor must make every single day above and beyond european ones.
As a compounding factor, the insurance rates mean that it's much, much harder in America to be a nurse practitioner than it is in Britain - you take many of the same risks, so the insurance is as absurdly high. Meaning a lot of minor procedures that don't actually need a doctor so can be done more cheaply without aren't,
The very high American education costs are passed on to the patients
The average american med student graduates literally $150,000 in debt - and Sally Mae is aggressive (and won't accept bankruptcies). British ones may have debts of about a third of that amount - but it doesn't honestly matter because they only have to pay back 9% above £15,000 for standard student loans. Say about 6% annual interest (going by the fixed rate amount) or about $10,000 per year after tax the doctor needs to go straight to just paying the interest on the loan. Throw in taxes, payroll and a need to do more than pay off the interest and the cost for the cheapest doctors in America has just risen by another $20,000 - or about $100 per working day. Plus with that much debt there's a much bigger incentive for greed. And once the loan is paid off the doctors don't go to lower rates.
So far the cost of an American doctor is therefore around $500/day above that of a European equivalent for no appreciable benefit.
(Insurance rates and education costs also apply to vets for what it's worth - although the insurance cost difference isn't quite so stark).
The treatment method is the most financially inefficient possible
In America if you are uninsured you more or less wait until you can go to A&E/the Emergency Room. That's about the most cost-inefficient method of treatment possible. It means that the condition is worse than it needs to be and makes planning harder and so overheads higher.
no subject
Date: 2012-08-25 04:54 pm (UTC)The Americans have the most bureaucratic healthcare system in the world
The doctors have separate rules for different patients
In Britain the list of authorised procedures is put out by NICE. A consultant only occasionally needs to look to see what's changed in what they are allowed to do or they need to see what they want to do as part of their research work. Given that it's fairly big news when things change, this takes a negligable amount of time. I believe that you have a similar system such that the costs and procedures that are approved are mandated centrally. In America, you need to know what insurance model your patient is on. You need to be up to date with dealing with a dozen separate possible insurance schemes, some of which have ... odd exemptions. And for each patient you need to know what treatment you can provide. This is a double overhead - first it means you need to spend some extra time per patient and second the hospital needs to be able to brief the doctors.
Line by line accounting
In Britain, the cost of your stay is based on very few factors - and it's assumed that other than some very expensive drugs and a few parts patients average out. In America they sometimes charge for as little as a nurse delivering aspirin. What they do not explicitely charge for is the time taken to write and bill all that crap rather than just put it in the medical notes, and supplying the wards with standard stocks of drugs but it's an overhead.
Legal defensive measures
In addition to malpractice insurance, the legal costs are higher - a further overhead. And this also encourages the doctors to do more diagnostic procedures, protecting themselves from any possible charges of negligance. This costs a significant amount of money - which due to the insurance model is cost-shared to consultations (partly to make consultations cost-effective for the money-hungry junior doctors with their $150,000 debts). Otherwise they'd do fewer of them. So due to the legal system not only is the malpractice insurance rate much higher, but so are other costs. Including administration fees.
The insurance companies are almost pure bureaucratic overhead - probably the biggest single issue
One of the things an insurance company does is checks through all the claims to find out reasons to not pay out. They do this to both patients, and to hospitals - on a line item basis. This means that the hospital needs to charge for everything - and it needs an entire team of specialised people whose job is nothing more nor less than wrestling with the various insurance companies. Medical benefits from this team: Nil. And the costs American doctors charge needs to be inflated because the insurance companies are going to try to avoid paying out whatever they can. (The discounts if you offer American hospitals cash rather than go through the insurance companies can be up to 89% as they don't have an arm-wrestling match to see any money - for the record, those cash prices still look slightly high to me; one of the parts of my job includes working out for a major UK hospital how much we get paid per visit).
no subject
Date: 2012-11-24 07:54 pm (UTC)no subject
Date: 2012-11-24 07:55 pm (UTC)(sorry for responding so late, comp was broken when I posted this, and I've been way too busy the past few months to go back to older posts)
no subject
Date: 2012-11-24 07:56 pm (UTC)no subject
Date: 2012-11-24 07:58 pm (UTC)as if.