The Insurance Companies have been the scapegoats for Health Insurance Costs for decades, when anyone could see that their return on investment is much lower than many industries. The same could be said for the Oil Industry where the taxes consumers pay per gallon outweigh industry profits by a large margin. It's the leftist goons that spread such disinformation. They are against anything corporations run. They believe the Federal Government can do so much better. Now that is the "joke" of the day.
So where is the wasted part? Hospital profits and physician expenses in my mind. I've not researched it but I think specialty physicians make a lot more than they did in the 1950's
And your solution would be? All of the percentages in the pictograph are not profits. Additionally I have always read that physician costs account for only 20% of healthcare costs: http://healthcare.dmagazine.com/2012/12/17/breakdown-how-the-healthcare-dollar-is-spent/ To get a real handle on healthcare costs there will have to be rationing which means the most frequent and highest volume users of healthcare will have to be rationed the most namely the elderly, the disabled, and those with chronic helath problems. Tell us which group we should begin rationing healthcare to first.
Then there's a graph that shows the breakdown of every dollar that goes to hospitals, one for doctors, one for the drugs, and so on. No one cares. All we see is huge amounts of money leaving our pockets and not much in return. Just like the oil industry (where I live) - no one cares what the breakdown and margin is. We see big shiny offices and rich dudes in suits. You're never going to get any pity or understanding. *We is a very generalized sweeping characterization of the overall public.
Dave I can understand your disdain for Christianity, I cant understand your constant mocking and tryin to tear down others beliefs.
The difference is insurance companies aren't blamed for higher gas prices. They were labeled as the leading problem during health care "reform." One of the elephants in the room is national, federal tort reform. But, that's a two-edged sword,and to the utmost, because you want bad physicians rooted out when they misdiagnose patients. I don't want someone cutting on me and mine if they've had a stack of malpratice complaints and suits. As to hospital costs, I wouldn't even know where to begin because I have no experience there other than selling insurance to hospitals here in Dallas. Outside of the risk management element, I'm not sure which part of running a hospital is causing their share of the pie to be so much. I just know that when I can buy a bottle of three dozen ibuprofen at 21st Century version of Five & Dime for $2, I probably shouldn't be billed for $100 a pill if I go to the emergency room. Something is very, very wrong there. And, I don't necessarily mean wrong criminally; I mean, wrong as far as management and delivery. I'll say this, politicians and special interest groups worked overtime to rake insurers and their CEOs over the coals for their salaries when they were shoving Obamacare down our throats. Why do we not get the same type of reaction against hospital CEO, pharmaceutical CEOs, etc.? Also, they've capped the amount that insurers can profit. Why haven't they done the same for pharma? I doubt many hospitals operate in the black. I've been lucky to insure one that did - but, it was a private hospital...so, there was heaps and gobs of cost consciousness there.
When I was in grad school my boss was directed to come up with the hospital charge master. He put a Lotus (that long ago) spreadsheet together and multiplied cost x 7 and went to lunch. Hospitals have to overcharge insurance companies to cover the uninsured. It's called the cost shift. So, insurance pays two ways. 1. as a percentage of billed charges or 2. at a multiplier of Medicare (cost). Hospitals and insurance companies do a dance to try to push the cost shift bubble back and forth. Aetna may pay Integris 32% of billed charges but BC/BS may pay them 185% of the Medicare DRG for that visit. And, oddly, that could be the same amount. The kicker is that , for Medicare participating hospitals, CMS (Centers for Medicare Services) will come in after the annual audit and either make you whole up to the Medicare rate (assumed to be cost) or they'll reduce your Medicare reimbursement rate over the next period to adjust for "profit". A hospital like OU Medical Center will have a Medicare rate of $12,000 for a procedure that Mercy may only get reimbursed at $8,000. And, Mercy is, typically, happy to get the $8,000. A hospital that keeps a busy OR and a decent payer mix can do OK these days. The issue is that the payer mix is not good in Oklahoma. That's why small hospitals are closing. Too many uninusured. You get to bill $58,000 for that procedure that Medicare will pay you $8,000 for but you're left trying to get $ from a turnip. $8,000 up front is way better than an uncollectable $58,000. The physician owned hospitals that I work with are outstanding as far as quality and costs go. They get a low Medicare rate (like $6,000 in the example above) but their unfunded care is negligible (they may do some pro bono stuff if they so choose to) because they don't have a ER. They are an example of why care costs less when everyone has a payer source. I have two close friends who are either VP's or CEO's at both rural and large urban hospitals. The small town guy is happy with Medicare patients. He can use them to keep even and, if he's doing good work, he can make "profit" on the privately insured patients. My friend at the "big hospital on the hill" whines and moans about the Medicare rate. It's all about your perspective. Personally, I think this all comes down to the insurance companies needing to keep their profit margin at a certain point and specialty doctors needing to keep their salaries high. Family practice docs aren't the problem. It's all those neurosurgeons.
What is the problem with neurosurgeons as far as costs go? Also, what about the pharma angle? How does pharma work into the cost as far as hospitals go? These things, I know next to nothing about.
That's the problem. There are so few people who know anything about this - and most of the ones that do create and control the problem.
I don't know about pharm too much. I know it's an expense. I can see why the companies need to get their money back off of their research. I think we have a bigger problem with over use of meds in general terms. I just use neuro as an example. Tulsa is a market that rolls deep in neurosurgeons. So, we see a pretty high rate of spinal procedures per capita in the eastern part of the state. A back procedure that was not really necessary carries costs well beyond just the cost of the procedure. In the last 20 years we've seen many of these spinal procedures go from being the last straw in lieu of physical therapy, medication management, chiropracty or even massage therapy to surgery is now the silver bullet. I see those who think they're going to get cured by the magic back surgery and they can't understand that the 100 extra lb's that they're puling around 24/7 is going to inhibit a successful spinal procedure over the next decade. We have an over abundance of some specialties (ortho, neurosurgeon's, etc.) while others are hard to find (endocrinology, nephrologists, etc.). Personally, I think it relates to relative income, the choices that young people make (endocrinology and nephrology aren't "sexy") and the fact that many docs come of out med school not wanting to be family practice physicians. And, to be fair, many of these choices are driven by the high costs spent on medical school.
