Comments on: What if everything worked like health care?

By: Joanne McIntosh

Joanne McIntosh — Mon, 15 Jul 2013 18:27:22 +0000

And that’s the bottom line, jlndewitt🙂
When you’re blessed with a team that works for/with you, then cost is a secondary consideration. All the price-shopping in the world is not going to replace what you seem to have right now. It works for you.
I’ve learned quite a bit just by reading your posts here..thank you for that.

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By: jlndewitt

jlndewitt — Mon, 15 Jul 2013 14:30:07 +0000

Joanne, you’re so right about wondering about where the rest of the 20k goes, when a surgeon might only get about $1500. When I have looked over bills after surgery, so much is poured into the radiology required to find a problem, pre-surgery care and medications, the room for pre-surgery, the operating room, the medicine for anesthesia, bill for the anesthesiologist, supplies during the operation, nurses and assistants during the operation, the cost of the recovery room, the recovery room nurses, then the post op care in the same pre op room and the nurses there…..of course it’s all kind of lumped in such a way that you can’t really see, for example, the exact price you paid for the hour you spent in pre op getting hooked up, examined, and dosed up and queried. Some of the cost is also in the post op doctor visits, stitches removal, etc.

Then of course there are all the administrative costs associated with everything else at the doctor’s office. Who knows how much is hidden in a cut for the upper management? All of my surgeons, and my internist, are in big (actually huge) groups. All of my surgeons have been very caring, patient centered, and extremely good at explaining procedures. Two of them, an orthopedic surgeon and a general surgeon, seemed to thrive on teaching me exactly what was wrong, what needed to be done, how it would be done, etc…… to the point of drawing pictures on the exam table paper. They are friendly and personable, even at 2 A.M.! For an abdominal problem, the surgery took much longer than expected…. eleven hours… because body parts weren’t cooperating, although it wasn’t anything dangerous, just tedious. It ended at about 10 pm and then my surgeon had to race off to two emergencies at other hospitals. ; a ruptured appendix, and a cancer patient. He apologized to my husband for having to be brief in his post op chat with him because of that, and my husband said that although he looked tired and sweaty, he still seemed to be energetic and was quick but very polite in his assessment. He promised to talk with him more later. He showed up back at my bedside at about 2 AM to check on the incision. I was pretty out of it but I remember that he apologized for coming in at that time, but said that he feared he wouldn’t make it for 6 AM rounds, and so wanted to stop by and check on me then. That next night they had to awaken him well after midnight in order to change a medication. So when you find that his portion, which has included all pre op and post op office visits, plus all the hours for the surgery and hospital checks, it doesn’t really seem all that enriching in terms of money.

I hope others realize that while it is true that their doctors do well financially, it probably isn’t anywhere near what we might guess. After paying off their medical school loans, yearly professional fees, malpractice insurance, continuing education, and whatever portion they have to pour into administrative costs at their practices, their salaries are not the megamillion ones that we imagine. But costs in this country are truly being scrutinized and my own internist now advocates a complete physical, with all the blood tests, etc. only every other year, and since I’m 61 and have never had any kind of problems with my reproductive system, I no longer have to have the yearly pap smear, etc. He did say that after 65 he would have to recommend that more often. He is very forward thinking and is part of the movement toward patients managing their own health with their doctor as a mentor.

He says that the focus in the future will be keeping patients healthy and hopefully keeping office visits way down, and that doctors might even be paid on a retainer type of system instead of the current “pay for a problem.” Doctors won’t be trying to find something wrong so that they can code something for the insurance company to pay for. I see huge changes coming, and I recently read on a health site that medical costs are already going down. Hopefully that trend will continue to reduce unnecessary tests and repeat hospital admissions.

At least now, the big dollar sign elephant in the room of wasteful medical costs is being addressed very seriously. I believe there really will come a day when a patient can shop a procedure and look at exact costs for everything. In twenty or thirty years, people will look back and be incredulous that we ever went in for an operation not having a clue as to the cost. I wonder if I would now ask about costs if I had to have another operation. Knowing that I wouldn’t go with a different doctor or facility anyway…. probably not, unless I was just curious about the bill ahead of me.

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By: Carolyn Thomas

Carolyn Thomas — Mon, 15 Jul 2013 12:11:48 +0000

You’re right, Dr. Joe. Here in Canada, we are equally ignorant of what even the most basic medical procedure costs!

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By: Carolyn Thomas

Carolyn Thomas — Mon, 15 Jul 2013 12:09:57 +0000

Hi David – I’m aware of your company and I too think you’re on the right track. My understanding, however, is that your services are for employers and health care plans – not for the vast majority of individual consumers of health care whose employers don’t subscribe to Castlight. I’m not an American, but I’ve heard that in the U.S. the cost of a basic chest x-ray, for example, isn’t carved in stone (negotiable for insurance companies, far higher for the uninsured, varies from hospital to hospital, etc.) That’s what happens when you have for-profit insurance companies basically running your health care system.

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By: Dr. Joe Kosterich

Dr. Joe Kosterich — Mon, 15 Jul 2013 11:28:43 +0000

A picture says a thousand words. A video may say ten thousand. Brilliant. And the principle applies in other countries too.

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By: David Van Couvering

David Van Couvering — Mon, 15 Jul 2013 05:37:09 +0000

I work at a great company called Castlight Health where we are working hard to bring real transparency – both on cost *and* quality – to health care. We work with employers, and then employees of those companies can use our tool to search for care using a very “consumer”-like experience. It’s been a real game-changer, IMHO. I think we’re on the right track!

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By: Kathleen

Kathleen — Sun, 14 Jul 2013 22:12:14 +0000

Inappropriate treatment and testing is far too common, and so is denial of appropriate treatment and testing. Some form of financial reward is usually at the bottom either way, and neither serves the patient.

The fact that people in midst of a health crisis are afraid to call an ambulance because of the cost – that speaks volumes.

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By: Carolyn Thomas

Carolyn Thomas — Sun, 14 Jul 2013 17:20:18 +0000

Good points, Kathleen. I suspect that awareness of what things actually cost is less important to comparison shopping during a health crisis (although some of my American counterparts routinely tell me of reluctance to call 911 during their heart attacks because they feared they would simply not be able to afford the ambulance). More to the point, it’s very important amidst the growing issues around pervasive rates of over-treatment, unnecessary testing, inappropriate screening recommendations, etc. Why, for example, does Manhattan have the lowest rate of knee replacement surgeries in the U.S. (4.0 per 1,000) while Lincoln, Nebraska, has the highest rate (15.7 per 1,000)? That’s a lot of very expensive surgery that’s simply not explained by the hospitals allowing this. More here on what doctors euphemistically call “practice variation”.

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By: Joanne McIntosh

Joanne McIntosh — Sun, 14 Jul 2013 17:12:46 +0000

Totally agree, Carolyn..

However, that would come under the section of transparency and accountability, and as much as we hear the lip service, I don’t believe such an open-book policy in lay-language will ever happen.

You’re right..it’s not “free”, we do pay for this healthcare thru our taxes, yet taxpayers have little or no input on how that money is spent. I ‘m not sure how it is out west, but here in Ontario, our hospitals are extremely top-heavy. It’s ironic, to listen to patter of how unsustainable our healthcare is, coming out of the mouths of hospital staff who are raking in 3-4 hundred thousand a year out of a 1 billion dollar annual budget. And when I see some sunshine-list manager cutting funding to much needed staff, services and programs, I fume helplessly.
I had started thinking that maybe the American healthcare might be better, and in terms of waiting lists and availability, perhaps it is. I don’t know enough about it yet.

I do believe, tho, that if Taxpayers knew the incredible amount of funding that goes into the bank accounts of desk-jockeys, there would be one heck of an uprising. Maybe that would be a good thing. Maybe that would finally bring change about.

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By: Kathleen

Kathleen — Sun, 14 Jul 2013 17:08:42 +0000

That video reflects a model particular to the U.S. health care business. In recent years there is a media push to blame Rising Medical Costs on “consumers” for insufficient “price shopping” and for making unreasonable demands when, as the video shows, few of us have access to price and quality information, or the leisure to carry on an investigation.

Recently a New York Times reporter tried to research ‘normal birth’ at local hospitals for her uninsured daughter, and simply could not get figures from most hospitals, even when she pulled out her Reporter card.

When we are sick or injured, we need and want the best care we can get for the best outcome. To worry about costs is counterproductive at that time (or any time).
Really, I think the whole bruhaha about costs is to distract us from where most of it goes. In the US, a huge proportion is devoted to insurance companies and fighting over who pays what. And to the profits of pharma and makers of medical devices. But mainly insurers, who produce absolutely nothing and have done so much to distort the process.

My brother is one of the few (anymore) who has an individual private practice, and nearly half the time of his office staff is devoted to fighting insurance companies for payment.

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By: Carolyn Thomas

Carolyn Thomas — Sun, 14 Jul 2013 16:31:16 +0000

Hi Joanne – I too live in Canada, where because of universal health care coverage, we are generally even more unaware of the total cost of our medical care. We don’t have to worry about co-pays or paying off hospital balances or being denied insurance coverage because of some small print disclaimer in our policies. But such care is not “free” – the taxpayers of Canada are footing the bills, and we – as taxpayers – should know what we’re paying for.

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