# How can we fix medical pricing? **URL:** \ **Category:** Great Debates\ **Created:** [August 25, 2021, 7:01am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475 "2021-08-25T07:01:16Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [August 26, 2021, 12:50am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/81 "2021-08-26T00:50:31Z")
> [@DavidNRockies](#): > > And the concept of reduced malpractice being the right kind of incentive for physicians ? IIRC malpractice lawsuits are a bugbear for medical professionals that bears little resemblance to reality. Certainly doctors are exposed to lawsuits but it is not the monster they (and insurance companies) keep making it out to be. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [August 26, 2021, 1:12am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/82 "2021-08-26T01:12:39Z")
I think that really depends a lot on which doctor and which city. I had a stent last November ( in NYC) , and in looking up the interventional cardiologist that would perform the procedure, I found an article that said the director of interventional cardiology at that hospital made about $5 million and the doctor who was going to perform my procedure earned a couple of million. I was unable to find that article now - but did find others that said the aforementioned director made $4.8 million in 2012, a spine surgeon earned $3.2 million, and the head of OB/GYN at a non-profit hospital was paid a salary of $283,427 and a bonus of $999,500. Now, I’m sure all those people are outliers- but I’m also sure that the other interventional cardiologists at the hospital where I got the stent aren’t earning $400K. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [August 26, 2021, 1:14am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/83 "2021-08-26T01:14:08Z")
> [@Whack-a-Mole](#): > > When I was in the hospital I was never given a choice to forgo some tests or have less blood taken or decide if I wanted to pay $30 for some aspirin. Never, ever, ever was I given a price list and any choice in what I was willing to pay for much less a chance to call other hospitals and price-compare for the best rate. But if you stop the nurse who is drawing blood and ask what is being taken and why, they’ll answer your question or get someone who can. Seriously? You wouldn’t ask? I must be a total dick. If blood is being drawn I’ve been told why ahead of time or I find out before the draw. I’m responsible for the cost, for Christ’s sake. . I’ve put a stop to totally unnecessary “Cover My Ass” expense. ---
**Author:** ![Richard\_Pearse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/richard_pearse/32/13144_2.png) [@Richard\_Pearse](https://boards.straightdope.com/u/Richard_Pearse)\ **Post date:** [August 26, 2021, 1:22am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/84 "2021-08-26T01:22:29Z")
> [@Voyager](#): > > Under ACA in the US, the overhead an insurance company can charge is limited to a certain percent of the payments they make to providers. So, the more payments, the more overhead, which include profit. Thanks. Unintended consequences of a reasonable rule. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [August 26, 2021, 1:22am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/85 "2021-08-26T01:22:32Z")
Have you been in the hospital for a week or more for some malady? At least where I was, constant blood draws were common. They’d wake me in the wee hours of the morning to draw blood (I forget but it was definitely daily draws and, for me, at least twice if not three times per day). I’m curious what would happen if you refused? Also curious if you refused if your final bill would reflect it. Not to mention, when you are feeling like shit, do you have the wherewithal to complain? ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [August 26, 2021, 1:33am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/86 "2021-08-26T01:33:17Z")
> [@Whack-a-Mole](#): > > I’m curious what would happen if you refused? I had a complicated cholecystectomy (gall bladder) that kept me in for five days. I had a JP drain, ICU recovery stuff. A nurse told me (off record) I was being released prematurely because my insurance was questioning the length of stay for the procedure. My day of discharge a nurse came for blood draw, CBC/CHEM, routine stuff. I refused. The previous days draw was entirely normal and I felt no worse. She made me sign my medical record as to my refusal. No biggie. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [August 26, 2021, 1:35am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/87 "2021-08-26T01:35:28Z")
Did you refuse because you knew it was unnecessary to your well-being? ---
**Author:** ![DeadTreasSecretaries](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deadtreassecretaries/32/4817_2.png) [@DeadTreasSecretaries](https://boards.straightdope.com/u/DeadTreasSecretaries)\ **Post date:** [August 26, 2021, 2:31am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/88 "2021-08-26T02:31:12Z")
> **[Severely Injured Woman Heroically Fights Off Paramedics Trying To Force Her...](https://www.theonion.com/severely-injured-woman-heroically-fights-off-paramedics-1844671492)** > > Hear how this woman was able to fend off her would-be assailants, and what you should watch out for if you hear sirens headed your way. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 26, 2021, 2:46am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/89 "2021-08-26T02:46:14Z")
> [@Whack-a-Mole](#): > > IIRC malpractice lawsuits are a bugbear for medical professionals that bears little resemblance to reality. > > Certainly doctors are exposed to lawsuits but it is not the monster they (and insurance companies) keep making it out to be. Right. This paper > **[The net effects of medical malpractice tort reform on health insurance...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701901/)** > > In this paper, we examine the influence of medical malpractice tort reform on the level of private health insurance company losses incurred. We employ a natural experiment framework centered on a series of tort reform measures enacted in Texas in... studies the impact of the 2003 Texas tort reform law, and claims that it has had little impact on medical costs or insurer losses. Maybe that’s why we don’t hear how limiting malpractice suits is going to fix the problem anymore. The Time article on high costs partly covers Texas after the reforms, by the way. ---
**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:** [August 26, 2021, 3:40am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/90 "2021-08-26T03:40:48Z")
> [@DavidNRockies](#): > > @Martin_Hyde : in terms of physicians, there’s an artificial scarcity component to _that,_ too (for any who may not be aware): > > [Thanks to doctors, there aren't enough doctors - Washington Examiner](https://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors) > > And you constantly read about (if you pay attention to such things) states that want to expand the practice of mid-level practitioners (ie, Nurse Practitioners and Physician Assistants) only to be strong armed by the AMA, et al, with cries that these mid-levels will _kill everybody they see_. > > ETA: that NP/PA part is also covered in the linked article (available through no end of other sources, too). > > Broken. Yeah, this is something I’ve mentioned in conversations before. The doctors have a pretty good “guild” in the AMA, that actively works to keep it hard for there to be lots of new doctors. They have powerful justifications too, “you don’t want to water down the talent, these are doctors.” I don’t have the data on this anymore, but I think I once read that we haven’t opened a new medical school in the United States since the 1970s. Existing medical schools have expanded in size, but nowhere near the pace of population growth. When you also factor in that emerging medical knowledge has lead to more people being able to get referred to a specialist to treat things that were often just left untreated back in the 1970s or earlier, the demand for doctors has gone up considerably. Since the “guild” has kept barriers to entry high, the actual measured barriers are higher than ever. You need almost a perfect undergrad transcript and amazing MCAT scores now. Which hey, if you barely cleared a 2.0 in an undergrad Phys Ed major where you took the requisite chem/bio courses to get eligible for med school admission, I’m probably fine with you being told no by a medical school. But someone who has a 3.5 and an undergrad degree in biology or chemist, scored well on MCAT? The fact that the only path for someone like that now is to go to grad school to “clean up” their transcript, then apply as someone with a Master’s, or to go to one of the “Caribbeans” (there’s like 4-5 Caribbean med schools whose graduates can get accredited in the United States, and it’s often a route for people that lack the GPA to get into American medical schools.) > [@doreen](#): > > I think that really depends a lot on which doctor and which city. I had a stent last November ( in NYC) , and in looking up the interventional cardiologist that would perform the procedure, I found an article that said the director of interventional cardiology at that hospital made about $5 million and the doctor who was going to perform my procedure earned a couple of million. I was unable to find that article now - but did find others that said the aforementioned director made $4.8 million in 2012, a spine surgeon earned $3.2 million, and the head of OB/GYN at a non-profit hospital was paid a salary of $283,427 and a bonus of $999,500. Now, I’m sure all those people are outliers- but I’m also sure that the other interventional cardiologists at the hospital where I got the stent aren’t earning $400K. Right, and if you ever notice, any time talk of provider compensation is brought up in most discussions, the “struggling doctor” is brought up. The struggling doctor isn’t fake. In fact there’s probably more struggling doctors than the ones you mention. However, there’s a big economic impact of one doctor drawing in the pay of 20 general practitioners (or more), or a fee 15x higher than a comparable British specialist. Those are probably big outliers, but surgeons and other specialists making 500k+ isn’t that rare at all. Note too that the ones who make the big money aren’t the ones who are going to be arguing that doctors are underpaid, they just will shrewdly avoid that discussion. Instead they make sure their sort of doctors are the ones who run the AMA and their kind of people run the AHA, and they set the tone for lobbying and influence peddling. I think I saw a poll once where a lot of individual doctors supported single payer, but the AMA has always been against it. Like most quasi-political institutions, the AMA is captured by the richest, most powerful doctors, it’s not ran by rural practitioners who are doing it for love of the craft. AHA is the same way, there’s small rural hospitals that are barely solvent now (some aren’t solvent without government aid), who likely would benefit in net from single payer, but you can bet the CEOs of those little rural community hospitals aren’t the ones pulling the strings of the AHA. In fact I just checked the listing of the AHA’s Board of Trustees–virtually the entire board are heads of very large hospital systems. I think maybe one isn’t (Bruce White, CEO of Knox Community Hospital.) ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 26, 2021, 3:54am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/91 "2021-08-26T03:54:49Z")
> [@Dark\_Sponge](#): > > Yes, this is the biggest issue. The 1000 bed hospitals in big cities may survive reform but the little dinky 25 bed hospitals in small towns are barely keeping their heads above water. If too many of those smaller hospitals go down we could see situations like a person with a heart attack needing a 2hr drive to get to an ER. > > I lean to the right but I don’t see a good solution other than moving to a single payer. The insurance companies have too much power. > > On a side note, the listed prices almost always include the wages of a person. It’s not that the bandage itself cost 97 bucks but that a nurse making $50 per hr put it on then checked on you 20 minutes later. We can have a vastly superior health system w/o single payer. Single payer is good, but a lot of nations still have multi payer systems and their health care is affordable and cost effective. Germany, the Netherlands, Israel, Switzerland, Japan, etc all have multi payer systems from what I know of them. The big issue is is the government willing to negotiate medical prices and is the health care system run with the goal of providing high quality care at a low cost (as opposed to making money by any means necessary like ours is). I think thats the big difference between us and other nations. I guess my point is that even with Emergency rooms charging $100 for a bandage, they’re still running out of money. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [August 26, 2021, 5:07am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/92 "2021-08-26T05:07:33Z")
> [@Wesley\_Clark](#): > > I guess my point is that even with Emergency rooms charging $100 for a bandage, they’re still running out of money. Really? ---
**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:** [August 26, 2021, 5:30am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/93 "2021-08-26T05:30:47Z")
Emergency departments are not typically profit centers for hospitals, they are typically very lucky if they break even. Normally they lose money, it is usually surgery–especially surgery requiring highly trained specialist surgeons, along with maybe things like diagnostics and etc that get hospitals into the black–if they are in the black. Some hospitals receive community support to continue operations due to operating at a loss. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [August 26, 2021, 10:57am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/94 "2021-08-26T10:57:54Z")
> [@Whack-a-Mole](#): > > Did you refuse because you knew it was unnecessary to your well-being It seemed nonsensical to repeat blood work that was all normal the previous day, plus I was concerned wether my insurance would cover it. Generally speaking, I’ve found that having an attitude of questioning what’s going on has saved me money and aggravation in medical settings. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [August 26, 2021, 11:25am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/95 "2021-08-26T11:25:18Z")
Another example. My PCP years ago ordered blood work. I read over the scripts and questioned all of the liver tests. Turns out my doctor saw my tattoos and piercings and thought I was at risk for hepatitis. I was a bit offended, as my work was done by close friends and done following the strictest hygiene, but I went along. Everything was normal. A few years later I saw my doctor for a gout diagnosis. Again he looked and saw my tattoos and piercings, so he ordered all the hepatitis panels again. He never bothered to ask if I’d acquired any new ink or piercings. I hadn’t. So, I refused the blood tests. ---
**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:** [August 26, 2021, 11:53am UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/96 "2021-08-26T11:53:38Z")
> [@kayaker](#): > > Generally speaking, I’ve found that having an attitude of questioning what’s going on has saved me money and aggravation in medical settings. The issue is not whether this is smart, and it is definitely smart. The issue is who should be doing the questioning. Should it be you, and me, and the rest of us untrained people, or should it be your doctor and other medical professionals deciding what is necessary and appropriate? Should we be deciding based on not knowing who is going to pay for it, or should it be decided based on solid medical grounds? Our current system incentivizes us to mess with our medical decisions in order to game the system and save money. I have an expensive test coming up… I’ll schedule it in January because that’s when my deductible resets, much better than having it in December when I’m guaranteed to pay full boat out of pocket. Of course, if I had already met my deductible for this year, it would be “foolish” to wait until January, I could get the test for free if I did it now. This entire line of thought is insane, the fact that I’m thinking it is insane, but I must do so because I got screwed over by a couple grand the last time I had an expensive December test, instead of waiting for January. ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [August 26, 2021, 1:07pm UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/97 "2021-08-26T13:07:37Z")
It may be too difficult to concisely excerpt these studies, but to point to yet another problem area in our health care system … providers are too often guessing wrong. > **[Accuracy of Practitioner Estimates of Probability of Diagnosis Before and...](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2778364)** > > This survey study of physicians, nurse practitioners, and physician assistants explores practitioner understanding of diagnostic reasoning. > **[Rate of diagnostic errors and serious misdiagnosis-related harms for major...](https://www.degruyter.com/document/doi/10.1515/dx-2019-0104/html)** > > Background Missed vascular events, infections, and cancers account for ~75% of serious harms from diagnostic errors. Just 15 diseases from these “Big Three” categories account for nearly half of all serious misdiagnosis-related harms in malpractice... > **[The incidence of diagnostic error in medicine](https://qualitysafety.bmj.com/content/22/Suppl_2/ii21)** > > A wide variety of research studies suggest that breakdowns in the diagnostic process result in a staggering toll of harm and patient deaths. These include autopsy studies, case reviews, surveys of patient and physicians, voluntary reporting systems,... To tie it in with the OP, there are ridiculous financial pressures under which health care facilities and personnel are forced to operate, since Big Medicine works backward from the bottom line – often forcing patients to do the same thing (h/t to @Cheesesteak ). Medicine has become assembly line. Missing your financial targets ? Speed up the line. What could go wrong ? Back to my analogy about crime and punishment, the **[DoJ](https://www.cnn.com/2015/03/06/us/ferguson-missouri-racism-tickets-fines/index.html)** found a similar dynamic at play when they investigated Ferguson, Missouri. > The millions of dollars in fines and fees paid by black residents served an ultimate goal of satisfying “revenue rather than public safety needs,” the Justice Department found. That’s America. The spreadsheet belies the humanity. Broken. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [August 26, 2021, 1:17pm UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/98 "2021-08-26T13:17:51Z")
> [@Cheesesteak](#): > > I have an expensive test coming up… I’ll schedule it in January because that’s when my deductible resets, much better than having it in December when I’m guaranteed to pay full boat out of pocket. I’m a little confused - if your deductible resets in January, wouldn’t that mean you would be paying the full cost of out pocket just like you would in December since you wouldn’t have met the 2022 deductible yet? ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [August 26, 2021, 1:24pm UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/99 "2021-08-26T13:24:32Z")
> [@doreen](#): > > if your deductible resets in January, wouldn’t that mean you would be paying the full cost of out pocket just like you would in December since you wouldn’t have met the 2022 deductible yet? It’s more that you may have to pay off some or all of _this year’s_ deductible, and then – if treatment continues – get hit by _next year’s_ deductible, too. ---
**Author:** ![Dark\_Sponge](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dark_sponge/32/121_2.png) [@Dark\_Sponge](https://boards.straightdope.com/u/Dark_Sponge)\ **Post date:** [August 26, 2021, 3:12pm UTC](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475/100 "2021-08-26T15:12:40Z")
> [@Martin\_Hyde](#): > > Emergency departments are not typically profit centers for hospitals, they are typically very lucky if they break even. Normally they lose money, it is usually surgery–especially surgery requiring highly trained specialist surgeons, along with maybe things like diagnostics and etc that get hospitals into the black–if they are in the black. Some hospitals receive community support to continue operations due to operating at a loss. Yes, surgery and radiology/imaging are the money makers for hospitals. Almost everything else loses money or breaks even. At the two hospitals I’ve worked at the ER was a major money drain, even with government funding to help cover the cost. [Previous page](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475.md?page=4) [Next page](https://boards.straightdope.com/t/how-can-we-fix-medical-pricing/949475.md?page=6)