And to end my random, jumbling narrative: Why do insurance companies insist on a thousand tests to determine I really, really need this surgery? Do they think I’m doing it for fun? Like I had nothing else to do that week, so I want a doctor to cut on my throat? I think a “need” for surgery is pretty self-selecting. How many perfectly healthy people demand heart surgery, for instance?
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You said it yourself: it’s the lawyers. 20% of all medical costs today go towards tests, most of which are not needed (Source: My father, who is a retired doctor, showed me the stat in a medical journal. I do not have said journal, so I can’t cite the exact name and issue, sorry). People with simple complaints that a $40 x-ray could diagnose 999 times out of 1000 are instead given $5000 worth of MRIs, CAT scans and God knows how many other tests on the off chance that they are the 1000th person, because if the doctor doesn’t order them, sure as shit stinks the resulting lawsuit is going to cost more than all of those tests, so the system becomes clogged up and billions of dollars are wasted. It’s pathetic. A little common sense-start with the basic tests and progress to the more expensive ones if the basic tests are not conclusive-would go a long way.
[QUOTE=Renob]
By consumer control I meant things like cost-sharing. Perhaps its not the right phrase to use. The way I think about “free” health care (whether provided by the government or insurance companies) is that there is little consumer control. Where you pay for it yourself you have the control. So that’s why I used that phrase.
On p. 25 through 27 the authors discuss the effects on health care. Basically, people who had to pay a part of their health care used less health care. But for the average person, their health was the same as the people who had free care (poor people showed worse health if they had cost-sharing).
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That sounds very plausible. I know a rise in the co-pay from $10 to $15 doesn’t impact my use of drugs at all, and so there would be no impact on my health.
I’ll take a look when I have a chance - thanks for the link.
And to end my random, jumbling narrative: Why do insurance companies insist on a thousand tests to determine I really, really need this surgery? Do they think I’m doing it for fun? Like I had nothing else to do that week, so I want a doctor to cut on my throat? I think a “need” for surgery is pretty self-selecting. How many perfectly healthy people demand heart surgery, for instance?
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Maybe they figure that all those tests save money if they show someone doesn’t need the surgery? Anyhow, I had the opposite experience. I had a cardioversion, and the only time I saw the cardiologist was when I found I had the problem and just before I went under. And the only test was a bit of bloodwork the day before. I go to the coumadin clinic every week, but that is cheap and fast.
[QUOTE=jtgain]
The doctor wants to schedule an appointment to discuss the results of my sleep study? Doesn’t he own a telephone? Why do I have to sit in his office for two hours for something he can tell me on the phone?
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I’ll tell you why – because the doctor doesn’t get paid for talking to you on the phone. He only gets paid if he sees you in person.
[QUOTE=jtgain]
So, it might seem I’m blaming the doctors, but the insurance is the one that insists on this. And they insist on it because of the trial lawyers on the back of the doctors on the back of the insurance companies.
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It’s not the insurance insisting on this. Think of it this way – the insurance company gets a fixed price every year to pay for your care. The less care you use, the more money they make from you. That’s why insurance companies are constantly try to promote less use of healthcare resources, rather than more.
If you’re interested in seeing why the doctors want you to have so many ancillary services and tests, it might be worthwhile looking into whether the doctors have a financial interest in these ancillaries and tests. They often do. Defensive medicine plays a role, but I’m convinced that’s often oversold as a reason.
The point I’m making here is that insurance companies have a role – for good and for ill – in trying to rein in healthcare costs. That’s part of the reason the plan laid out in the OP keeps them in the game.
[QUOTE=Weirddave]
You said it yourself: it’s the lawyers. 20% of all medical costs today go towards tests, most of which are not needed (Source: My father, who is a retired doctor, showed me the stat in a medical journal. I do not have said journal, so I can’t cite the exact name and issue, sorry). People with simple complaints that a $40 x-ray could diagnose 999 times out of 1000 are instead given $5000 worth of MRIs, CAT scans and God knows how many other tests on the off chance that they are the 1000th person, because if the doctor doesn’t order them, sure as shit stinks the resulting lawsuit is going to cost more than all of those tests, so the system becomes clogged up and billions of dollars are wasted. It’s pathetic. A little common sense-start with the basic tests and progress to the more expensive ones if the basic tests are not conclusive-would go a long way.
[/QUOTE]
I’ts not the lawyers – it’s the doctors. Under the guise of practicing defensive medicine, the doctors send patients for unneeded tests, often in facilities they have a financial stake in. Imaging is one of the most profitable services out there. There’s a reason why every physician practice now wants to get an MRI, CT, even PET machine in their office.
From the New York Times: “Numerous studies have found that doctors order more tests and procedures when they have a financial interest in the equipment and clinics used to perform such services. In Florida, for example, a state agency said that doctors’ ownership of laboratories and diagnostic imaging centers tended to increase the use and cost of those services without improving access to care.”
[QUOTE=Weirddave]
You know, running the government on $48 Bil/yr doesn’t sound bad to me, maybe we could dial the federal government back to what it was supposed to be, you know, like in the Constitution? I’m trying to see a downside, but it’s eluding me.
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So, you’re still pretending to be a Democrat?
Cite? (Other than “I think”?)
Sorry, but I was responding to the proposal contained in your post. I wasn’t responding to what “people proposing tax credits and HSAs” are saying, but to what you were saying. My mistake, I’m sure.
[QUOTE=Sal Ammoniac]
I’ts not the lawyers – it’s the doctors. Under the guise of practicing defensive medicine, the doctors send patients for unneeded tests, often in facilities they have a financial stake in. Imaging is one of the most profitable services out there. There’s a reason why every physician practice now wants to get an MRI, CT, even PET machine in their office.
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I’d like to see some laws limiting the financial stake doctors can have in things like this. I’d also like to see some limits on drug advertising, especially the direct-to-consumer “ask your doctor” type ads. I suspect those lead to unnecessary doctor visits and unnecessary prescriptions, as well…
