How to Avoid Getting Screwed -Healthcare Costs, Mole Removal

[Trackhead]

Seems logical and what I expected. It would be nice to utilize healthcare for legit complaints and not fear the “gotcha surprise” bill we get here. Patients ask how much XYZ costs and we can’t even tell them because nobody knows.

It’s fucked up, obviously. And the bulk of the cost is administrative bullshit.

[bennymac]

Having studied both systems neither of them are remotely close to perfect.

And a lot of people (patients and doctors) will naturally and understandably latch on to the headlines showing that the system on the other side of the fence is so much worse than theirs.

Or they’ll report on their family member who got screwed over by the system in a way that they legitimately shouldnt have and extrapolate that out to the millions of people who got great care and then went on living their lives (and that doesn’t become a story that is told because its not sensational)

Where you see a lot of the cracks in a system like Canada’s is due to what was a well functioning system from the middle of the last century now buckling under the weight of an aging population coupled with all the medical advancements (and their costs) and the demands of that population that they receive any and every treatment option possible no matter the clinical indication or expectation of success - add in the post pandemic world and sprinkle some “states rights!” talk from the conservative lead provinces wanting to bring the “efficiencies” of for-profit corporations into health care and you have yourself a system struggling to stay afloat.

The hip and knee replacement patients shout the loudest (not to downplay their situations) but the people that get most screwed by the situation in Canada is often the newly diagnosed cancer patients. They don’t need imaging or surgery that same day - but they need investigations and treatment very urgently. The Canadian system doesn’t fail all these patients - but it fails way more than it should (the goal of any system should be to not fail any of these people)

[Trackhead]

Good to hear cogent non-political first hand observations…

[old goat]

Billing and coding in any hospital organization is by the book. We get feedback fairly frequently from coders, and I can assure you hospitals are not submitting fraudulent claims with any frequency. You’ll get your ass in hot water real quick with that many eyes on fraudulent submissions. Private practice? Maybe? But we’re all here essentially talking about hospital based care.

And yes, insurance companies pay attention. We get called out all the time over admissions, having to do “peer to peer” phone conversations with insurance company physicians arguing why we are admitting their patients and them refusing to pay or whatever else. Then there are prior authorizations for imaging studies, etc. Insurance companies aren’t dumb. They run the fucking show.

That “fraud” citation is from scammers not false claims submitted by hospitals per the article your podcast cited.
https://www.propublica.org/article/h...s-who-pays-you

old goat: makes sense…I was looking at your story from an ER perspective, sorry

I agree--out and out fraudulent claims are an organized criminal enterprise carried out by a relative few. What percentage get caught I have no idea but there's a few every quarter in the California Medical Board report. What I do see is a little upcoding--coding a legitimate visit at a higher level of care than was actually provided. (I've seen this for care i and my family have received outside of Kaiser. At Kaiser we don't code. They tried to teach us and gave up.)

Now they're starting to do what is basically a heart lung machine for people who have cardiac arrest out of the hospital. The cost and institutional effort has to be enormous. Now, if we just put the same dollars and effort into preventing 60 year olds from having heart attacks (or young mothers dying in childbirth).
https://www.nytimes.com/2024/03/27/m...smid=url-share

[Trackhead]

Are you talking ECMO? A buddy of mine had out of hospital arrest, ended up on ECMO for a few days and came out the other end with a functional brain. He was late 40s at the time. Still doing well.

But yeah, we go pretty damn far here in the states, just because we can I guess.

[bennymac]

Published yesterday:

Medical Debt in US Linked With Worse Health, More Deaths

An estimated 8% of US adults, or about 20 million people, live with medical debt of at least $250, based on recent survey results from the nonprofits Peterson Health Center and KFF (formerly Kaiser Family Foundation). The majority of those with medical debt owe more than $1000.

Now, a study that examined data from 93% of US counties found that the burden of unpaid medical bills might be affecting physical and mental health as well as shortening lives.

Increased medical debt was also linked with more premature deaths and more deaths from any cause, including cancer, heart disease, and suicide.

“[A] consequence of accessing health care should not be worse health”

https://jamanetwork.com/journals/jam...rm=032924&adv=

——

I’m not sure how they accounted for socioeconomic issues and all the potential confounders. But the statement “a consequence of accessing health care should not be worse health” struck me. That should apply to any medical system.

[bodywhomper]

Wow, that's quite a multiplier, especially over just one year! Just out of curiosity, what was a typical monthly premium in the previous year compared to the current year? Did it shoot from something like $50 to $300, or $200 to, gulp, $1200?

Kaiser, for a family plan, went from $2301 to $15,481, annual, with the same coverage.

[XXX-er]

How long do patients wait for CT, ultrasound, MRI after it’s ordered? Who determines urgency and wait times?

This report paints a wait time Americans would not accept. I end up doing prior authorizations on I’d say less than 10% of the CTs I order in the outpatient setting. Two reports show Canadians waiting weeks for imaging studies.

https://canjhealthtechnol.ca/index.p...ew/HC0052/1170

https://radiologybusiness.com/topics...t-times-canada

Curious on your real world explanation.

so less facilities mean longer waits, during covid i waited 2 months for an MRI and 6 months for the surgeon to do an ACL but I didnt pay any out of pocket whereas i notice americans in the gimp thread are talking about 6k out of pocket to do an acl , It hurt somewhat but I could wait altho someone i know got her ACL done much faster cuz her knee was locked up while I was still mtn biking

people might wait if they didnt have to pay out of pocket and they got no other choice

BTW there are no " insurance companies" no copay just the Medical Services Plan AKA the government

[fomofo]

Kaiser, for a family plan, went from $2301 to $15,481, annual, with the same coverage.

Fucking Hell, that's insane!

[rod9301]

Insurance is a collective (can you say “socialism”?) process. I remember when my mother in law who had MS for 40 years also was diagnosed with Leukemia. She ended up in the hospital for well over a month and due to the skilled nursing and other extensive treatment her prior condition required she rang up in excess of $1mil. Luckily my FIL was on a health insurance plan from a golden parachute buy out in the 90s so between that and Medicare they had very little out of pocket expenses. The many of us pay for years into the system to help offset those costs. Well, and the execs need their ski homes too, right?

It sounds like your family had excellent health care but don’t confuse that with the “best health care in the world” trope. Singapore, Norway, the Netherlands, and another few dozen other counties have objectively better care than the good ol USA. For what we pay, we should have such a better system.

I would say almost every country in the EU has really good health systems, and much cheaper.

A couple of years ago, hospital day rate was about $500 a night in France.

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[rod9301]

The system worked for me and I am happy to have had the access I did. Would I have liked it to be cheaper? Sure, everyone would. I also recognize the profit motive has led to the US leading the world in medical advancement and development over the past 100 years that those other developed countries take distinct advantage of. If the development costs were more evenly distributed globally that would certainly help the US system cost wise.

That's such propaganda.

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[rod9301]

If you think about it, of course we pay too much. We even pay so much that the for profit companies are rolling in $. But they aren't just rolling in $, they have so much profit that they are able to pay an army of people to try to fuck everyone over. We pay so much we literally pay an army of people who are trying to to fuck us into paying even more. So fucked up.

Fuck the insurance companies! Universal health care please.

And the amount of money spent by the medical system( drugs, hospitals, etc) is obscene, not to speak that drug advertising is illegal in most developed countries.

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[rod9301]

Seems logical and what I expected. It would be nice to utilize healthcare for legit complaints and not fear the “gotcha surprise” bill we get here. Patients ask how much XYZ costs and we can’t even tell them because nobody knows.

It’s fucked up, obviously. And the bulk of the cost is administrative bullshit.

The administrative bullshit is so true.

I spend winters in France. The local doctor practice, similar in size to the one in Truckee, has one admin, who also answers the phone. At the end of a dr visit, you give them the insurance card and it's done, no billing. If you don't have insurance, you pay 30 dollars on the spot.

I don't know how many admin the practice in Truckee has, but just in the front office there are at least 3-4 people and I'm sure there are more someplace.

Also, you go to a doctor in France, no nurses that have to be in the room also, like in the US.

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[Peruvian]

I did the math - with a 42% tax burden there would be ~$10.5 trillion dollars of tax revenue per year, given the current (2022) GDP estimate of $25.4 trillion.

Seems like we oughta be able to figure out universal health care with that kind of money... just need to increase taxes.

The Koch Brothers funded a study that confirmed this.

[MagnificentUnicorn]

That's such propaganda.

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A lot of innovation and technology is developed in the EU and used clinically for years sometimes before it’s in widespread use in the US. Who’s riding who’s coat tails?

In reading about different healthcare systems around the world, France seems to me to have the best system. Their system is is more privatized than the US, insurance companies have to compete for customers over there. Their countrywide EMR and billing system is very efficient. Is it perfect? No. It’s way better than our system and far more equitable for everyone.


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[Trackhead]

Country wide EMR? Say it ain’t so!

You mean when Tom Dick or Harry show up in an ER unconscious in another state/province the ER provider can actually see their medical history on a universal system?

I thought the US was the tech leader. Sends a man to the moon in the 60s, but can’t have a universal EMR….

[MagnificentUnicorn]

Not only is it universal, the card vitale, you bill at the time of service and reimbursement is required within 48 hours.


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[Conundrum]

Kaiser, for a family plan, went from $2301 to $15,481, annual, with the same coverage.

Did the base premium actually increase that much of did your employer back off their contributions or did you change jobs? A family plan without employers contributions or subsidies has been no where near $2,301 annually in the US in a long time

[Conundrum]

Not saying your out of pocket premium didn’t change. Saying that on top of about a national 8-9% trend increase for base cost, employers are backing off their share in a lot of cases as part of the ongoing wage suppression, especially for dependent coverage.

[rod9301]

Did the base premium actually increase that much of did your employer back off their contributions or did you change jobs? A family plan without employers contributions or subsidies has been no where near $2,301 annually in the US in a long time

My wifes, insurance, healthy, went from 300 to 1,200 a month in maybe 4 years.

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[MagnificentUnicorn]

I’m pretty stoked, I got an email from the VA last week and through the PACT act they are extending 100% health coverage for all Gulf War veterans. This will allow me to transition to part time and full retirement years earlier.


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[Conundrum]

My wifes, insurance, healthy, went from 300 to 1,200 a month in maybe 4 years.

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Bummer.

[bennymac]

I’m pretty stoked, I got an email from the VA last week and through the PACT act they are extending 100% health coverage for all Gulf War veterans. This will allow me to transition to part time and full retirement years earlier.


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Nice!

[bodywhomper]

Did the base premium actually increase that much of did your employer back off their contributions or did you change jobs? A family plan without employers contributions or subsidies has been no where near $2,301 annually in the US in a long time

Not saying your out of pocket premium didn’t change. Saying that on top of about a national 8-9% trend increase for base cost, employers are backing off their share in a lot of cases as part of the ongoing wage suppression, especially for dependent coverage.

My employers contribution was not shared, and coworkers that I know all reluctantly left Kaiser. My premium, switching insurers (never been Kaiser), went up 10%. That employee low premium for Kaiser and the equivalent in NE was a known item and used as incentive for employee recruitment and retention. The drastic increase was viewed by staff and senior managers (AVP’s/VP’s, but not executives) as a pay cut.

[house]

It’s fucked up, obviously. And the bulk of the cost is administrative bullshit.

This is partially true, but the whole system is bloated and costs for EVERYTHING are grossly inflated. It’s just a result of the system being built with profits as goal with quality/equity being a distant second and third (probably further down the line than that even)

The unspoken truth (because doctors/health professionals are held in such high regard) is that salaries are also inflated. Yes, med school debt. Yes, grueling training. But is the gulf between what US docs make and the rest of the rich countries’ docs not a sign that this cost center is also a factor? My dad is a retired physician so I don’t fault anyone for getting paid (I have benefited from it!) but it’s part of the whole system that we need to somehow get in check. The only solution is single payer. Anything short of that will perpetuate the bloat.

https://www.washingtonpost.com/busin...-pay-shortage/


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