Health Care Thread

chaos_sl said:

Yes, considering the fountain of evidence you have provided to the contrary it is just amazeballs.

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Id be willing to bet he comments on theblaze articles regularly, he seems like a barely functioning retard without the conversational skills that most of them have.

Xequecal_sl said:

Why does this bureaucracy exist if it's not needed? If it was superfluous, the insurance companies would have gotten rid of it a long time ago. To say otherwise is to claim that they hate making money and/or don't know how to run their own companies and are wasting the money. This is why the enforced 80/20 split from Obamacare is so retarded, all it does is make everything cost more. They wouldn't devote more than 20% to "bureaucracy" if they didn't maximize profits by doing so, and since there's no "excessive" profits for any savings to come out of by enforcing this, either, it's just a terrible idea.

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You do realize that before the ACA, the average insurance company besides Medicare (which ran around 20% administrative costs) ran something like over 60% of it's costs as administrative costs, right? More was being spent on the bureaucracy that they themselves made than they did in actually paying for people's coverage.

For almost every insurance company in our nation they followed the same trend.

PS - The "Medicare/Medicaid" figure is bullshit to put that way, it's MEDICAID that has $550b of help - MEDICARE gets $50b and only indirectly (Pharmacy and Premium assistance for Medicare is done via Medicaid which is that entire tally) - Medicare, besides the two caveats I listed there which are helping poor people that have Medicare is completely self-sustaining.

Vaclav_sl said:

You do realize that before the ACA, the average insurance company besides Medicare (which ran around 20% administrative costs) ran something like over 60% of it's costs as administrative costs, right? More was being spent on the bureaucracy that they themselves made than they did in actually paying for people's coverage.

For almost every insurance company in our nation they followed the same trend.

PS - The "Medicare/Medicaid" figure is bullshit to put that way, it's MEDICAID that has $550b of help - MEDICARE gets $50b and only indirectly (Pharmacy and Premium assistance for Medicare is done via Medicaid which is that entire tally) - Medicare, besides the two caveats I listed there which are helping poor people that have Medicare is completely self-sustaining.

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Lets say it really was 60% administrative costs. Who cares? That must have been the most efficient way to do it. Saying otherwise is claiming the insurance companies are all incompetent at running their own businesses or they had a motive other than money, which are both ridiculous. If they were spending that much on administrative costs it was because they were seeing returns from doing so. Forcing 80/20 on them can only reduce their efficiency and make stuff cost more. The myth that insurance companies were making a killing denying claims just can't be true when their profit margin is that low. They could have done 80/20 themselves at any time if that would have increased profits. Why would they waste money on "unneeded" bureaucracy for no reason?

Obamacare can be a win from a social justice standpoint, now people with pre-existing conditions that aren't their fault can actually get insurance, and now so can poor people that couldn't afford it before. But you have to remember that those new rights cost money. Claiming Obamacare saves money is the height of stupidity. It does not address the out-of-control costs in any way, and those people now have these rights because you are subsidizing them.

With regards to Medicare, $50 billion is only the Part A deficit. Most people don't realize this, but the payroll tax for Medicare is only supposed to pay for Part A, and it's only covering ~80% of Part A costs at the moment. Part B is entirely financed by deficit spending and so are the shortfalls for Part D. (the premium you have to pay to get Part D comes nowhere near to covering the costs)

Also, I work in a hospital lab. I have access to our lab's price list, which lists what we pay for all the chemicals and reagents we use. It's very interesting to compare these prices to, say, what Sigma-Aldrich charges the public for exactly the same reagents. I can tell you with certainty that the markups for our lab start at ten thousand percent and go up from there. For example, yesterday we got a delivery of a 1% silver nitrate aqueous solution from Dako, they charge us $5,950 per liter for this. Remember that's a1%aqueous solution, which means we are buying silver nitrate for $595per gram.That's over a 20,000% markup from what you'd pay to buy reagent grade AgNO3 from Sigma-Aldrich. You can buy pure, solid platinum for less money than they are charging us for this. This kind of shit pervades the entire healthcare industry and is the main reason everything costs so much. Just like a caterer triples the price when they figure out they're catering a wedding, companies will just add a few zeroes to their prices when they realize they're selling to a hospital. In my opinion, this is also the main reason insurance companies were all administrative costs, it wasn't to deny claims, it was to try and root out this ridiculous price gouging as much as possible.

The "efficiency" the extra administrative costs saved actually weren't a net savings to the system as a whole - it was extra auditors to find reasons to DECLINE CLAIMS for any reason they could find, which then led to a spiral of offices having to hire more office workers to get the claims paid to the office.

So sure, it saved them money - but at the cost of the rest of the system costing more. When I worked my first job as a records clerk for the practice my mother was an RN for we literally had claims that were STILL being fought by the time I moved onto another job about 15 months later that were being fought for one day 1.

And on Medicare - you're apparently ignoring the fact that you pay a Premium for A and B of $108/mo (I think? It was $105 last year and there should've been an adjustment with the COLA if memory serves) that's why there is no actual shortage - and FYI payroll tax on Medicare covers closer to 60% - premiums that are paid for A/B are a HUGE amount. (Note: Had to double check - technically it's a Part B premium for how it's referred to - but it + payroll is currently in excess of what B needs to operate, the overflow is allowed for A - it's possible as demographics shift that B might not have overflow to offset A - however that's not the case TODAY or for any projections I see)

Now D does have problems, but that's why it's being removed - the ACA actually is making Part D sunset for the most part - it's reduced in how much they suggest it now that you can't get information on it at a SS office anymore for Christ's sake.

And medical parts costs are a problem, and one that the ACA doesn't target, but it's tangential to the largest part of the equation - parts is about 20% of medical costs before the ACA, 40% was service, 40% were administrative/insurance or something like that. It's like talking about tort reform as a serious thing in it, sure it's a larger part of the equation but it's not the largest hunks of cost right now - more sensible to work on the most costly parts then move onto the smaller ones next.

[But don't get me started about all the screwed up stuff with Pharma's I'll go on for a while - my father until he retired in 2006 was a cardio-renal pharmaceutical reviewer for the FDA (and the national expert on pharmaceutical photostability for what that's worth...) so I've got all sorts of horror stories of costs and patent abuse and the like that the FDA is pretty much hogtied into being complicit with while most of the reviewers and the like don't want this shit to go on]

fanaskin_sl said:

not saying cutting out the middle man(especially insurance companies) wouldn't save cost, but SOME of that cost goes towards funding innovation and profit motive and all that, it's not COMPLETELY useless.

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Insurance companies want less innovative solutions, bro. Better knee transplant costs them more than the old standby. And due to them generally paying out partially with max charge agreements any savings on innovations for existing procedures ends up going to the doctors.

fanaskin_sl said:

no, fuck insurance companies, I was talking about the people who ultimately issue the bill.

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Insurance is the only middleman in the equation, if you're hating on them who do you think is beneficial within the middlemen?

There are a few others but most of them are tangential or largely insurance related. (I.e. hospital administration)

Lets say it really was 60% administrative costs. Who cares? That must have been the most efficient way to do it.

Why even bother talking after this? dumb.

It's like when charities pocket 60 to 70% of donations for administration costs. Who cares? That must have been the most efficient way to do it.


(okay I don't really care either)

Picasso_sl said:

Lets say it really was 60% administrative costs. Who cares? That must have been the most efficient way to do it.

Why even bother talking after this? dumb.

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The most efficient thing for them to do is refuse every claim... that's what the administrative costs were largely for were to find legal grounds to refuse to pay for care.

So yes, efficient for the insurance company - for the providers and the clients using their services? Not at all.

Xequecal_sl said:

I can tell you with certainty that the markups for our lab start at ten thousand percent and go up from there. For example, yesterday we got a delivery of a 1% silver nitrate aqueous solution from Dako, they charge us $5,950 per liter for this. Remember that's a1%aqueous solution, which means we are buying silver nitrate for $595per gram.That's over a 20,000% markup from what you'd pay to buy reagent grade AgNO3 from Sigma-Aldrich.

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Generally selling materials for medical applications will see SOME sort of markup vs. industrial use because of the extra hoops you have to jump through to vet your product for the customer.

But that markup is pretty insane, and it would be interesting to see their justification. Even sigma is somewhat of a high baseline for raw materials (generally 2-3x higher), or they charge 1000 a kilo for something of similar quality costs 50 elsewhere in the more extreme cases.

The only rational guess about that price point is that it's such a simple product, and such low profit margin that they "offer it" but it's not worth their time to produce/vet unless they charge that amount.

There's more to it than that Remmy. Nitroglycerin pills for human vs. vet use are literally made under the same standards with higher dosages for horses, yet the horse nitro pills cost hundreds of times less (maybe even thousands, been ages since I've found out).

So, this piece of shitWhy AOL ended up spending millions on 'distressed babies' - The Term Sheet: Fortune's deals blogTerm Sheet

First he announces that they have to cut their 401k's because "Obamacare." But then he backpedals and confuses the issue by talking about how in the last year they had to pay out a million each for a couple of problem pregnancies. Which not only means that they were self-insuring to try to save money (so he gambled and lost), but also so fucking cheap that they had either no catastrophic cap at all or a ludicrously high cap. So because he gambled and lost he was going to pass it on to his employees by cutting their 401k matching. Note that AOL is far from struggling to turn a profit. What a fucking shitbird. Surely, what we need is less government regulations so that our benevloent corporate benefactors are better able to look after our interests. Because nothing ever gets lost in the name of profits.

But what I'm curious about - originally he blamed Obamacare. Does this mean self-insurance like this is supposed to go away, and he was citing the increased cost of providing his employees actual insurance, or was he just flat out lying and scapegoating?

And also, wouldn't a company that self-insures like this be extremely unlikely to hire anyone over 30, or women of breeding age?

Picasso_sl said:

Lets say it really was 60% administrative costs. Who cares? That must have been the most efficient way to do it.

Why even bother talking after this? dumb.

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The point is that if insurance companies are only making 3-5% profit before the ACA, then doing something to significantly increase their outlays is necessarily going to make premiums cost a lot more because there's no "excess" profits for that additional money to come out of. As such, you can definitely say Obamacare is a win from a social justice standpoint, as it cuts down on people getting denied on bullshit technicalities. But a lot of people are claiming that Obamacare actually saves people money, and that's absurd. It can't possibly work like that.

The fact is that 60% administrative costs got you insurance a lot cheaper than you would have had to pay for it otherwise. Those auditors and lawyers wouldn't have been hired if they didn't save the company more than the company had to pay them in salary, and 3-5% profit margin means those savings were necessarily being passed to the consumer. It kind of sucks that the doctors/hospitals have to deal with the fallout but the consumer doesn't see this aspect. In addition, I can't see how these auditors can be all that detrimental. They force the doctors, pharma companies, and medical supply companies to keep costs down if they want stay in business. Besides, there's a limit to how much the insurance companies can shortchange the doctors. If they do it too much, the doctors will go broke. If that happens, their plan is now worthless and nobody will buy it, because there's no doctors left on it for their customers to go to.

Remmy_sl said:

Generally selling materials for medical applications will see SOME sort of markup vs. industrial use because of the extra hoops you have to jump through to vet your product for the customer.

But that markup is pretty insane, and it would be interesting to see their justification. Even sigma is somewhat of a high baseline for raw materials (generally 2-3x higher), or they charge 1000 a kilo for something of similar quality costs 50 elsewhere in the more extreme cases.

The only rational guess about that price point is that it's such a simple product, and such low profit margin that they "offer it" but it's not worth their time to produce/vet unless they charge that amount.

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It costs that much because it's shipped to us in proprietary stainer cartridges for use on the Dako stainer. You know, just like inkjet printer cartridges. The stainer doesn't work if we don't get the supplies from Dako in their special cartridges, which is why we're forced to pay that much. In fact, the stainer is actually designed to self-destruct if you attempt to refill the cartridges or use counterfeit ones to save money.

Why did we buy a stainer that we knew would cost this much in supplies? Well, all the stainer vendors do this shit, so we can't just buy from someone else. And because of liability issues, we can't hire someone to do the stain by hand. Since the stainer is automated, the stainer makes every slide look exactly the same. If it's done by hand, there are small variations in the staining intensity and quality, especially between the control slides and the patient slides, because the control slides have been sitting in a warehouse for months before coming to us while the patient slides were surgically removed from the patient yesterday. This gives a malpractice lawyer ammunition to use against the doctor. "Look here, all these control slides are lighter than all these patient slides, and he signed off on it. He's obviously lazy and incompetent because he was signing off on poor quality slides, which means he must be responsible for my client's problems. Please pay us $100 million." You think a jury of 12 random people is going to understand that the controls are qualitative staining controls, and only meant to be good enough that you can confirm a positive or negative result? The same jury that definitely already has a lot of sympathy for the suffering plaintiff and knows the doctor will not be personally responsible for any judgment? Of course not.

In smaller medical labs that can't afford automated equipment, it's already pretty common for the lab techs to simply repeat the stain on the control slides until it matches the patient slides. This is of course borderline fraud and defeats the purpose of doing a control at all, but it's better than getting sued.

Xen, nope.