# A Pitting for the local Small Town Medical Clinc **URL:** \ **Category:** The BBQ Pit\ **Created:** [June 30, 2012, 8:06am UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786 "2012-06-30T08:06:25Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [July 2, 2012, 3:34pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/61 "2012-07-02T15:34:33Z")
> [@bengangmo](#): > > Given what you spend on health care compared to the rest of the world, Americans should all be living to 136. > > How much you spend is an example of what’s wrong with your system, not what’s right That’s what I said…that you could use spending numbers to highlight some of the problems with the American system. Did you read my post? It seems like you maybe did but got the exact opposite point. (I know you’re joking about the 136 thing, but it’s worth pointing out at a certain point using current medical technology medicine can only do so much…and medicine can’t fix national policy or national habits that might cause deleterious health effects.) ---
**Author:** ![Cat\_Whisperer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cat_whisperer/32/4839_2.png) [@Cat\_Whisperer](https://boards.straightdope.com/u/Cat_Whisperer)\ **Post date:** [July 2, 2012, 4:42pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/62 "2012-07-02T16:42:17Z")
> [@leahcim](#): > > \ > It’s not a \*great \*system\ My nomination for “Understatement of the Year.” 🙂 ---
**Author:** ![gamerunknown](https://avatars.discourse-cdn.com/v4/letter/g/6bbea6/32.png) [@gamerunknown](https://boards.straightdope.com/u/gamerunknown)\ **Post date:** [July 2, 2012, 5:05pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/63 "2012-07-02T17:05:16Z")
> [@Rand Rover](#): > > Must have been a really quick look. Canada has had higher unemployment than the US for a long time . . . up until the current recession caused the US to catch up. That same story holds true for many other western democracies with universal healthcare. Which is irrelevant. Milton Friedman holds that unemployment is necessary in a Capitalist system. Quality of life for the unemployed and employed are the important things to look at. When wages are declining relative to top earners, it’s obvious quality of employment will decline as purchasing power declines in a zero sum system (ownership of land and other finite resources). > [@Rand Rover](#): > > If someone believes that the health care system in country x is better than the one in country y, they have the burden to support that argument. I have simply been showing how looking at life expectancy alone does not support that argument, which is all i need to do. Uh, very well. Before going into this, I’ll qualify that we won’t be able to establish causation. We’ll be able to disprove certain factors as being significant impacts on lifespan outcomes, with several caveats. One of those is going to be cultural factors: countries with programs designed to counter drink driving may have higher rates of alcohol consumption and still have fewer fatalities where alcohol is a factor. In other countries, alcohol may be restrictively expensive and marijuana more widely available for certain groups. There may also be a feedback loop: alcohol could contribute to low quality of life outcomes, which in turn depress a countries economy, driving more people to drink. Likewise, public health services may also provide treatment for alcoholism or obesity. Hyper-dependence on capitalism and 9% of the GDP being expended on advertising could also influence alcohol and food consumption. Another thing to note is that lifespan is subject to diminishing marginal returns, so will not have a linear relationship with most factors, especially not public healthcare expenditure, With those things in mind, let’s look at the numbers. Here’s a source determining [alcohol consumption per capita](http://en.wikipedia.org/wiki/List_of_countries_by_alcohol_consumption). Of the countries spending within three standard deviations of the [US per capita on healthcare](http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_%28PPP%29_per_capita) (WHO data), 13 had higher rates of alcohol consumption than the US. Of those, 7 had rates of reported alcohol consumption over 1 standard deviation of the US, with one having total alcohol consumption over 1 standard deviation higher than the US (Ireland). There was no data on alcohol consumption for San Marino or Monaco. All of the countries listed had higher lifespans than the US. All had lower [infant mortality](http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate). [Cigarette consumption](http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita)? Five countries within three standard deviations of US expenditure on healthcare had higher cigarette consumption. No data on Monaco, San Marino or Luxembourg. None were higher by a standard deviation, though all had higher standard of living outcomes. All of the mentioned countries with higher cigarette consumption also had higher alcohol consumption. I address obesity in relation to infant morality [here](http://www.wowhead.com/forums&topic=110098.81/news-articles#p3154584). I address homicide rates [here](http://www.wowhead.com/forums&topic=110098.118/news-articles#p3206376). While none of the countries within that three standard deviations of expenditure have a higher murder rate than the US (or obesity rate), murders are far less important than other factors in contributing to lifespan. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [July 2, 2012, 6:05pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/64 "2012-07-02T18:05:16Z")
Heck, could the U.S. gets its stats up to those of other western democracies if they covered their 30% currently uninsured? For that matter, even with the ACA, is there still an uninsured gap of people who can’t afford insurance (or at least not useful insurance, i.e. they can only pay for plans with absurdly high deductibles, and thus skip basic care until something catastrophic happens), yet are not poor enough for medicaid? ---
**Author:** ![Meyer6](https://avatars.discourse-cdn.com/v4/letter/m/cc9497/32.png) [@Meyer6](https://boards.straightdope.com/u/Meyer6)\ **Post date:** [July 2, 2012, 10:56pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/65 "2012-07-02T22:56:13Z")
> [@Cheesesteak](#): > > The problem with this is the end result. Folks with the least money are faced with 2 choices. Pay 2.5x the “real” price of $75, or be a deadbeat. This isn’t a $10 convenience fee we’re talking about, it’s an enormous additional charge, applied to people who clearly have the least money to pay it. Like I said, I am not a proponent of American-style healthcare, and I really do think that poor people in the US are getting the short end of the stick, but the OP is not doing much to garner sympathy. If he had started the thread as ‘our healthcare system sucks’, I wouldn’t have a problem with that, but instead he targeted his ire at the clinic and specifically the receptionist. Presumably neither the clinic or the receptionist have the option of not charging people at all. And if the clinic decides to charge everyone the same, regardless of whether they will pay now or later, then a lot of the ‘I’ll pay later’ types will just go on their merry way and not pay at all. So they kind of have to have a two-tier system. It makes perfect sense to me. What is it that you think the clinic should do? ---
**Author:** ![gamerunknown](https://avatars.discourse-cdn.com/v4/letter/g/6bbea6/32.png) [@gamerunknown](https://boards.straightdope.com/u/gamerunknown)\ **Post date:** [July 3, 2012, 12:15pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/66 "2012-07-03T12:15:48Z")
Forgot to mention an extraneous variable of infant mortality in the US: [home births](http://www.sciencebasedmedicine.org/index.php/the-tragic-death-toll-of-homebirth/). [COBRA](http://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Reconciliation_Act_of_1985) excludes pregnancies without complications from the mandated care a hospital must provide. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [July 3, 2012, 12:48pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/67 "2012-07-03T12:48:07Z")
> [@Meyer6](#): > > And if the clinic decides to charge everyone the same, regardless of whether they will pay now or later, then a lot of the ‘I’ll pay later’ types will just go on their merry way and not pay at all. Is this not true when you charge the “I’ll pay later” types 2.5x the going rate? If they’re going to choose non-payment, does it matter if it’s $75 or $200? > [@](#): > > So they kind of have to have a two-tier system. It makes perfect sense to me. What is it that you think the clinic should do? First thing, they should not have a chump price and a real price. Second, they can charge a reasonable fee for structured payments. Third, they can have significant penalties +reasonable interest for failure to pay. Folks may be more willing to pay if they don’t feel taken advantage of. ---
**Author:** ![kp\_72110](https://avatars.discourse-cdn.com/v4/letter/k/e68b1a/32.png) [@kp\_72110](https://boards.straightdope.com/u/kp_72110)\ **Post date:** [July 4, 2012, 6:07pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/68 "2012-07-04T18:07:59Z")
This is borderline “GD” now. BTW- I Went and offered them the $75 even though the doctors procedure didn’t work. They said it was too late but I could still give them the $75 towards my final bill which with doctors procedure and all comes to a little over $400. I just laughed and told her “Yeah, hang on to that dream. As long as I owe you you’ll never be broke”. She was not amused. The lump did scab over and fall off but the lump started to grow again so I did some home surgery and will see how that works. On the bright side I did come up with an alternative to the Single Payer System. In my system you put all of your medical bills in my name and then I don’t pay them. I call it the “Single Blamer System”. Thank you. Please no applause. But you may kiss my ring. ---
**Author:** ![Meyer6](https://avatars.discourse-cdn.com/v4/letter/m/cc9497/32.png) [@Meyer6](https://boards.straightdope.com/u/Meyer6)\ **Post date:** [July 5, 2012, 1:50am UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/69 "2012-07-05T01:50:10Z")
> [@Cheesesteak](#): > > Is this not true when you charge the “I’ll pay later” types 2.5x the going rate? I assume that there are some honest people who will pay the bills the owe, so they have to keep raising the price until the income from those people outweighs the cost of the cheapskates. That sucks for the people who do pay (big time), but I can see how it happens. I do appreciate what you’re saying - it is an inherently flawed system. To my mind this is one of the biggest problems with private health care - some people are never going to pay their share, even if they can. So they have to keep jacking up the cost to the people who do pay. FWIW, I’m very sympathetic to people who genuinely cannot afford needed healthcare, but it’s hard to feel for people who just decide they’d rather not pay even though they can. > [@kp\_72110](#): > > I Went and offered them the $75 even though the doctors procedure didn’t work. They said it was too late but I could still give them the $75 towards my final bill which with doctors procedure and all comes to a little over $400. I just laughed and told her “Yeah, hang on to that dream. As long as I owe you you’ll never be broke”. She was not amused. Well, colour me surprised that \*that \*technique didn’t work. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 5, 2012, 4:07am UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/70 "2012-07-05T04:07:14Z")
Medical pricing: Contracts are signed with a variety of insurers. The contracts each specify that they will pay X for code 123 and Y for code 345 or the charges, whichever is less. X for insurer one is way way low but Y is pretty high and the opposite for insurer two. Averaging X and Y for each insurer comes up with pretty fair payment. How do prices get set to get that average? What happens if they charge that fair average? Each insurer pays less than that charge on their low paying charge and only the fair average on the other one and on average they are paying less than a fair amount. To get what the insurers will actually pay they have to price full retail at least as high as their higher paid codes, knowing that they won’t actually ever get it from them. Full retail price in medicine is a fiction … except for the uninsured. A very unfair circumstance that only those who can least afford full retail are put into a spot of being asked to pay it. So what do practices do … they try to make it fairer for the uninsured. As I understand it they cannot have “dual fees”, they cannot charge one thing to a payor and something else to someone without insurance. It’s illegal, considered fraud. They _are_ however allowed to offer a cash payment upfront discount (a “prompt payment discount”). Save them the billing process and potential for a collection process and they can spare you the fiction of full retail and actually charge you what they actually end up getting paid at the end of the day (or maybe even discount it more knowing that you are the ones who can afford it the least). A patient like this op, who’ll “gladly pay you Tuesday for a hamburger today” is bad news though. He’s a Wimpy who’d also complain about the burger. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [July 5, 2012, 9:35am UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/71 "2012-07-05T09:35:32Z")
> [@Meyer6](#): > > I assume that there are some honest people who will pay the bills the owe, so they have to keep raising the price until the income from those people outweighs the cost of the cheapskates. That sucks for the people who do pay (big time), but I can see how it happens. It’s not so much that they have to raise prices on people who pay. It’s that the highest price of all is paid by people with the least means. ---
**Author:** ![LurkerInNJ](https://avatars.discourse-cdn.com/v4/letter/l/ed655f/32.png) [@LurkerInNJ](https://boards.straightdope.com/u/LurkerInNJ)\ **Post date:** [July 5, 2012, 1:54pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/72 "2012-07-05T13:54:55Z")
Where are these doctors who send you a bill for their services? Every doctor I have either met or heard of required full payment at time of service. Cash, credit card or pre-approval by your insurance company. Are there really places in the USA where you can walk into a doctor’s office, get treated and then blow off the bill? ---
**Author:** ![kp\_72110](https://avatars.discourse-cdn.com/v4/letter/k/e68b1a/32.png) [@kp\_72110](https://boards.straightdope.com/u/kp_72110)\ **Post date:** [July 7, 2012, 2:22am UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/73 "2012-07-07T02:22:30Z")
So doesn’t the fact that I tried to pay them negate the “theory” that they were only charging me so much because I possibly wouldn’t pay them? Of course now you can officially call me a “deadbeat” because I’m simply not going to pay them this outrageous bill for something that did nothing for me except provide me a bill for services I consider not rendered. Anyway, I’m done with this thread. Have fun and Bless you all. Word to your mother and all that jazz. ---
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [July 7, 2012, 8:16pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/74 "2012-07-07T20:16:47Z")
One problem is that these clinics and private practices like to MILK two visits out of you when one would suffice. If I come in with an issue and tell you I have already tried the OTC options don’t send me home without a script and advise me to try the OTC option AGAIN and to come back for another office visit if it doesn’t work and I need a script, fuck you doc the cost and time I took off to come here isn’t trivial to ME even if it is to you! I am really sick of biting the bullet and saying well I guess I have to spent the money only to then be advised to try the OTC remedy, you idiot of course I tried that first! ---
**Author:** ![elbows](https://avatars.discourse-cdn.com/v4/letter/e/b3f665/32.png) [@elbows](https://boards.straightdope.com/u/elbows)\ **Post date:** [July 7, 2012, 8:48pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/75 "2012-07-07T20:48:15Z")
The time for this thinking, is when you’re with the doctor, not afterward. I can certainly see why that would be annoying. Another reason, ‘for profit’ should not be introduced to healthcare, I suppose. Next time maybe just speak up, and say, “I can’t easily afford another visit, time off work or money, and I tried the OTC, can you recommend something else?” ---
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [July 7, 2012, 9:19pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/76 "2012-07-07T21:19:12Z")
> [@elbows](#): > > The time for this thinking, is when you’re with the doctor, not afterward. I can certainly see why that would be annoying. Another reason, ‘for profit’ should not be introduced to healthcare, I suppose. Next time maybe just speak up, and say, “I can’t easily afford another visit, time off work or money, and I tried the OTC, can you recommend something else?” Yea I always speak up, but I know not everyone is comfortable with that. My mother in the USA just dumped her GP because she asked for pain meds for pain that has her unable to sit down or sleep, she wanted some kind of low level pain med. She is in her 70s and has never had a RX for pain meds in her life except after surgery probably, she has rheumatoid arthritis which she has somehow managed to bear through. The doctor wrote her a script for 800mg ibuprofen, after she told him it and other OTC meds were not helping. He told her to give him a call if it didn’t help and he would get her something stronger, she called and the office person told her she’d have to schedule a visit to see the doctor as the law doesn’t allow him to call in scripts(pretty sure this is not true, as he has examined her in the past) but ok she did it. At the office visit the doctor walked in and told her he doesn’t RX any narcotic pain meds at all period, but he will refer her to a pain specialist and she can make an appointment. She got really angry and stormed out, and is now working with her insurance to find another GP taking patients. This is the same doctor who made her feel like shit by freaking out on her and telling her to go elsewhere when she asked him if he could go through her ten prescriptions to eliminate the less needed stuff because she couldn’t afford them all at my advice, after she told me she was buying fractions of RXs and alternating taking them due to lack of funds. I mailed her some acetaminophen 500mg/codeine 8mg tablets which are OTC here and she is using them for the pain, that is how fucked up the USA health system has become. ---
**Author:** ![Canadjun](https://avatars.discourse-cdn.com/v4/letter/c/76d3ee/32.png) [@Canadjun](https://boards.straightdope.com/u/Canadjun)\ **Post date:** [July 7, 2012, 9:56pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/77 "2012-07-07T21:56:45Z")
> [@grude](#): > > I mailed her some acetaminophen 500mg/codeine 8mg tablets which are OTC here and she is using them for the pain, that is how fucked up the USA health system has become. Be careful. Remember that acetaminophen does very nasty things to your liver if you take too much of it. I am NOT criticizing the intent of what you are doing, just expressing the concern that she might run into problems if she is taking other products containing acetaminophen as well. ---
**Author:** ![Chimera](https://avatars.discourse-cdn.com/v4/letter/c/8e8cbc/32.png) [@Chimera](https://boards.straightdope.com/u/Chimera)\ **Post date:** [July 7, 2012, 9:59pm UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/78 "2012-07-07T21:59:48Z")
You’d also have to be careful because that would be considered trafficing in narcotics and could result in a rather stiff jail sentence for dear old mom. ---
**Author:** ![The\_Niply\_Elder](https://avatars.discourse-cdn.com/v4/letter/t/8e8cbc/32.png) [@The\_Niply\_Elder](https://boards.straightdope.com/u/The_Niply_Elder)\ **Post date:** [July 8, 2012, 8:01am UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/79 "2012-07-08T08:01:42Z")
> [@Rand\_Rover](#): > > Nope, you’ve just proven yourself to be a moron. You apparently believe that life expectancy numbers prove which country has a better healthcare system. That is obviously moronic, as I will illustrate with an example that even you should be able to understand. > > Take Island A and Island B, both with a population of 100 people. > > Island A has 10 doctors, all of whom were educated at Harvard and have Nobel prizes. The other 90 residents eat nothing but bacon, smoke 4 packs a day, and drink 2 bottles of wine a day. Island A’s most popular hobby is Russian Roullette. > > Island B has 1 doctor, who got his degree in veterinary medicine through an internet correspondence course based in Nigeria, and he’s killed every patient that’s ever seen him (even those who showed up with minor problems). The other 99 residents are the perfect model of physical perfection, always eating correctly and getting plenty of exercise and sleep. > > The average life expectancy on Island A is 42 years and Island B is 78. > > According to you, Island B has a far superior health care system than Island A. You’d apparently go to Island A, tell them to fire those 10 Harvard-educated idiots, and hire a guy with an online vet degree who kills every patient. Sorry for being late to the thread party and all, but this is the single fucking stupidest argument I have read all year, and to wit, we’ve had our fair share of trolls up till now I think you’ll agree. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [July 8, 2012, 9:17am UTC](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786/80 "2012-07-08T09:17:13Z")
> [@The\_Niply\_Elder](#): > > Sorry for being late to the thread party and all, but this is the single fucking stupidest argument I have read all year, and to wit, we’ve had our fair share of trolls up till now I think you’ll agree. To fully appreciate the analogy, one must mentally incorporate the unspoken assumption that there is a third island filled with alien robots. [Previous page](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786.md?page=3) [Next page](https://boards.straightdope.com/t/a-pitting-for-the-local-small-town-medical-clinc/626786.md?page=5)