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I have a close friend who is a veterinarian.  His clinic is across the street from my place of work.  When I am procrastinating I like to walk across the street and visit my friend.  Doc lets me watch him do surgeries and lab work.  He is skilled at every surgery from orthopedics to hysterectomies and castrations to bowel resections and tumorectomies and ophthalmology and oral surgeries.  He does the bulk of his own lab work.  He does radiology and diagnostics and regular check ups and trauma care and dermatology and infectious disease care and on and on and on.  He has one skilled helper who monitors the general anaesthesia and gives injections.  He has one other helper who answers phones and does the prescription filling and clean up of the O.R.

Doc had four years of under grad science and four years of vet school.  And he did an internship for a year.  He is required by law to get many hours of continuing education every year.

He is a highly trained professional in a profession that has a more competitive schooling than human medical schools.  With only one veterinary school in the entire state it takes a lot more oomph to get accepted than it does to get accepted to medical school.

Pooties and woozles and bunnies and horsies are near perfectly analogous to humans.  And yet they each have unique characteristics which affect diagnosis and treatment.

So, if Doc's DVM education is on par with an MD, and Doc's patients are anatomically on par with an MD's patients, why the hell does the price difference in one of Doc's bills vs an MD's bill approach 100 fold?

I have seen Doc, in the course of less than an hour, perform an hysterectomy on a dog (a major operation requiring general anaesthesia), set the patient in a recovery room for a couple of hours and then hand her over to her person with a bill for services rendered of around $240.

Then I get a cough.  It takes 3 hours, two separate locations and about $210 (mostly paid by insurance) to get a little bottle of cough syrup from the people clinic and the pharmacy down the road.

No wonder insurance companies are tight with the purse strings.  The medical establishment are practicing highway robbery.

I call Doc's office because my woozle has a bloody sore on her shoulder.  In 30 minutes my dog is on the exam table and Doc and his helper are doing wound care.  15 minutes later doggie is happily off the table and snuffing around and I am being handed a bottle of prescription antibiotic pills and prescription antibiotic spray.  I go to settle up at the front desk, see the bill for $30, prepare to pay and Doc says it's on the house.

I get an infected bug bite on my leg.  Deciding to tough it out I get a high fever and red lines running all along my leg emanating from the bite.  So I call the clinic and they direct me to the ER.  I sit there for about an hour after being interviewed by two different people regarding my ability to pay.  Then I am directed to a room where I sit for another hour.  Finally a physician's assistant comes in, takes a look, tells me I have cellulitis and I need a prescription for antibiotics.  She tells me to wait there while she gets me the paper work.  So I sit for another 40 minutes waiting for my paper work.  Then I go to the pharmacy, pay the co-pay, and finally get the pills.  A month later I get the insurance statement detailing the costs and what is covered and what I owe.  I have great insurance coverage so I owe very little.  But the insurance company paid out several hundreds of dollars.  Plus it took about 4 hours and I had to go through about 6 different people (none of them MDs).

I am certain plenty of people out there have similar stories.  I am blessed to have health insurance.  And it is a good thing too.  Because if I was paying cash I'd have been taking huge hits for a bottle of cough syrup and a bottle of pills.

I have lots of family who are MDs and RNs and nurse practitioners.  They are deserving of the healthy pay they get.  But holy fucking shit if the medical industry does not gouge people who are at their mercy.  The medical industry...Charges.  Too.  Much.  

All the hullabaloo around healthcare coverage these past years and I never hear it talked about.  Time magazine finally broke the silence a couple months back by asking the question (remember the PayMaster story?).  But there has been nothing ever since.

The medical industry is important but they are too self-important.  They, like the insurers have lobbied congress to get sweet deal laws on the books at the public's expense too.  Requiring a prescription for cough syrup that has as much chance of being addictive as that useless over the counter stuff?  I should have gotten the stuff in 10 minutes for about 6 bucks.  Instead it took 3 hours and my insurance company paid them $210.  

I recognize it will cost more to treat a human than an animal because we put the animal in a cage after surgery rather than a recovery room and because Doc blasts the blues on his stereo but the hospital and clinic pipes in nice elevator music.  Could that account for a cost difference of triple or quadruple?  Maybe.  But why would it be 100 times as much?  A hysterectomy for $240 anyone?  $2,400?  It'll run a human patient $24,000 easily after all is said and done.

I visit all the hospitals in the area as part of my work.  It is rare that a hospital is not undergoing some major renovation and expansion.  It is near constant.  I like a nice clean and pretty hospital too.  But do they really need a major renovation annually?

In the affordable healthcare debate, the insurance companies have done a lot to deserve criticism.  But the medical industry owns a huge amount of blame for millions of people not getting the healthcare they need too.

Originally posted to Simul Iustus et Peccator on Wed Oct 02, 2013 at 04:39 PM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Your Vet is probably the best diagnostician (33+ / 0-)

    you'll ever meet. They have to figure out what is wrong with a patient without using language. Often they have to treat patients that try to bite them, fight them and/or try to escape. And they have to deal with a patient's advocate who often as not is emotionally attached and not always rational.

    If I ran this circus, things would be DIFFERENT!

    by CwV on Wed Oct 02, 2013 at 05:15:52 PM PDT

  •  Another diff between vet & MD (11+ / 0-)

    the Vet's patients can't talk, and can't point to where it hurts, so the vet actually has to be a better diagnostician than an MD (unless we are talking about Pediatrics).

    As for the cough syrup, when I was younger, everyone in a rock band I liked drank Vicks Formula 44 like it was Jack Daniels. It had a lot of alcohol and was a fairly cheap drunk. But for those who needed it as cough syrup, it was easily available at the local store. No hiding it or making it prescription because it was being misused.

    I reject your reality and substitute my own - Adam Savage

    by woolibaar on Wed Oct 02, 2013 at 05:17:30 PM PDT

  •  Wow (22+ / 0-)

    All of your points are cogent, and quite relevant to the subject at hand. However, I can't help but be repeatedly distracted by the fact that you have just about the cheapest vet I've ever heard of.

  •  you convinced me. (23+ / 0-)

    from now on i'm just gonna see the vet.  ours has better magazines than the clinic anyway so that's a win right there.

    my mom never breast fed me. she said she only liked me as a friend.

    by bnasley on Wed Oct 02, 2013 at 08:04:09 PM PDT

  •  I wish I could rec this 100 times. (20+ / 0-)

    Instead of recognizing that the medical profession gouges us sixty ways to Sunday, people on this site appear to believe that docs are suffering under this oppressive regime - that they are justified in refusing Medicare or Medicaid because it doesn't pay them enough to get by.

    Bullfeathers.

    Every physician I've ever known lives in the lap of serious, serious luxury.

    And you're also right about vets.  It's very, very difficult even to get into vet school, and I've never met one who I thought charges enough!!

    "If there are no dogs in heaven, then when I die I want to go where they went." - Will Rogers

    by Kentucky DeanDemocrat on Wed Oct 02, 2013 at 08:11:08 PM PDT

  •  Why? It's simple. (15+ / 0-)

    When it comes down to it, to 99.99% of people, an animal is not a person, and is worth intrinsically less -- substantially less in most cases -- than a human life.  At some dollar amount, you just have to sadly say "Well, I guess we'll just put Fido down, then," or "Well, he's still eatin' OK, we'll put it off."

    On the other hand, most people would go far into debt to ensure their health and well-being, much less their life.

    This is why health care isn't anything like a 'free market' -- 'promise to pay me $X or you die' will practically always result in the person promising to pay.

    •  When I was younger, my ob/gyn used forceps to (12+ / 0-)

      deliver my son, and crushed his skull. The doc who did the surgery on him, nineteen days in neonatal ICU followed, was not selected by me, and sent us a bill for a huge amount. WHen asked about it, he said simply."I saved your son's life." Period.

      For eons, the decisions of doctors about such things were not challenged, except by insurance companies when such policies became common. As a group they are not used to having their unilateral decisions challenged, as everyone with a parent in his or her final days may discover about what the doc will do and only tell you later.

      This has made docs as a group very wealthy (my family had three of them), and that meant that Rs hunted them down and cultivated them. There is a reason the Rs relentlessly push what they call malpractice litigation reform, and that is it. That wa also mentioned as one of the issues Rs expect to raise in exchange for not killing the world economy. Nobody has any business challenging the unilateral decisions of doctors.

      •  But your experience is why we NEED (5+ / 0-)

        malpractice suits. That doctor is free to crush more skulls. I am not saying try to gouge him; but he should pay for all the care he necessitated plus more for pain and suffering because that covers the lawyer.

        Malpractice suits costs so much todo cause the doctor's insurance company's lawyer who is on an hourly retainer fights every step of the way and tries to draw it out.

        Most claims eventually settle for a reasonable amount — eventually. But by not making a claim against him and forcing him to pay you caused your insurer to pay and that sort of thing, repairing the damage caused by bad medical care, is a good part of why the premiums are so high.

        Forceps are NOT supposed to make that sort of damage. My kid was delivered by forceps and he just had a misshapen head for a few days. And that wouldn't have happened if they hadn't drugged me up so much.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Thu Oct 03, 2013 at 04:19:03 AM PDT

        [ Parent ]

        •  I don't think malpractice suits are effective (3+ / 0-)
          Recommended by:
          JerryNA, cocinero, wozzlecat

          at correcting poor practices or disciplining doctors.

          For one thing, they depend very much on the financial cost of the damage rather than the magnitude of the error. The damages if a doctor orders a ridiculously wrong medication and harms or kills an 80 year old patient are very low, compared to that of a slight misjudgement or even just bad luck with an infant who then needs lifelong care.

          We have a hundred thousand deaths a year due to medical errors. It's higher than other nations and it's not going down.

          Instead, I think a more open system with clear discussion of mistakes and an opportunity for doctors to discipline errant peers would be more successful, coupled with a single-payer arrangement that ensured that anyone who was injured by a medical error got the care that they needed.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Thu Oct 03, 2013 at 09:09:36 AM PDT

          [ Parent ]

          •  Doctors who simply have "bad luck" should win (0+ / 0-)

            when they're sued.  

            •  But they don't, necessarily. (0+ / 0-)

              More importantly, they don't believe that competence protects them. And being sued at all is not a happy thing, even if you "win" - as in, don't have to settle, don't have to pay a judgement.

              And, if this is our procedure for stopping medical mistakes,  doctors who make egregious errors should be sued always.

              But they aren't, necessarily.

              http://prescriptions.blogs.nytimes.com/...

              Do you have numbers on injuries and claims?

              A.
              The best data on medical errors come from three major epidemiological studies on medical malpractice in the 1970s, 1980s and 1990s. Each found about one serious injury per 100 hospitalizations. There hasn’t been an epidemiological study since then, because people were really persuaded by the data and it’s also very expensive to do a study of that sort. These data were the basis of the 1999 report from the Institute of Medicine, “To Err Is Human.”

              Q.
              And what percent of victims make claims?

              A.
              Those same studies looked at the rate of claims and found that only 4 to 7 percent of those injured brought a case. That’s a small percentage. And because the actual number of injuries has gone up since those studies were done — while claims have remained steady — the rate of claims is actually going down.

              Imagine you go to the emergency room with appendicitis. For whatever reason, they fail to diagnose it. Your appendix bursts, and you spend a couple weeks in the hospital. I’ve had lawyers tell me they would not take a case like that, even if it’s a slam-dunk. The damages wouldn’t be enough — medical expenses, maybe a month of lost salary, although the patient might have short-term disability insurance that would cover a large part of that. It’s not enough to justify going to court.
              The medical malpractice system only works for serious injuries. What it doesn’t work for is more moderate ones. Lawyers discourage people from bringing suits if their injuries are not serious in monetary terms — a poor person or an older person who can’t claim a lot in lost wages. That’s why obstetrician-gynecologists pay such high premiums. If you injure a baby, you’re talking about a lifetime-care injury. Gerontologists’ premiums are exceedingly low.

              Fry, don't be a hero! It's not covered by our health plan!

              by elfling on Thu Oct 03, 2013 at 10:34:01 PM PDT

              [ Parent ]

  •  Couple of things (24+ / 0-)

    First, vets are often struggling financially these days, especially younger vets. People are vets because they dearly want to be.

    It's also more physically dangerous, especially for large animal vets.

    Veterinarians are amazing. One of our favorites did surgeries not just on different species, but different classes: she did multiple species of birds, reptiles, and fish along with your more everyday dogs and cats and the like. Consider how much more knowledgeable of diseases and anesthesia and pharmaceuticals she had to be than a typical MD.

    My horse veterinarians come to my house. They're usually here within 10 minutes of the appointment time and every minute of the time here is spent with me and my animals. There's no sitting for 45 minutes in a room, waiting. No 15 minute wait with the clerk to check out. I usually speak directly with my vet when making the appointment, too. Why it is that if I drive my child to the pediatrician it takes over an hour for vaccinations, and yet my horse vet can get 3 horses vaccinated with 4 shots and looked over in half an hour, I can't really understand. The horse bill is less, too.

    But, on the other side, vets are very price aware. They know exactly what everything costs. They carry their medicines and what they don't carry, they also know the current market price. A friend of mine who is a vet was telling me that one of the vets that sometimes covers for her tends to be more spendy and aggressive in treatments. "It's not that the care isn't appropriate," she said, "but what happens is that the bill ends up being a few hundred dollars more... and then that horse's teeth don't get done that year."

    They think about everything they do, and they talk about cost a lot.

    They also have the option to let animals go. If my mare had been a human, someone probably would have insisted she go to a hospital and have a full diagnostic and lots of tests. We looked at her age, and her history, and decided it didn't matter exactly why, that she was quite old for a horse, and that she was checking out. That in the end there was not much we could do to change that. Her death was not expensive, and it was not prolonged.

    And finally, even worst case, your liability as a veterinarian is quite a bit less than as an MD. Generally, your patient has a cash value. You might be on the hook for some medical bills, but a bad malpractice case for a vet is probably tens of thousands, rarely more. And because the damages are low, there's not a lot of interest from lawyers in pursuing those cases unless they're billing hourly, which means the client is paying up front.

    If your mistake permanently damages a child, you could be on the hook for millions just in actual damages for that child's lifetime care. If your mistake were to permanently damage a horse, you'd be out the value of the horse and the horse would probably be euthanized or put out at pasture and not generate any additional bills.

    But yeah, I'd rather my vets treated me any day. Not only are they wicked smart and super experienced, but they know me way better than any human doctor does.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Wed Oct 02, 2013 at 09:04:55 PM PDT

  •  Certainly the Medical Industry charges too much (5+ / 0-)
    Recommended by:
    Powell, ColoTim, Wee Mama, Sparhawk, terabytes

    But I think you're missing something here. A human life is worth (much) more than an animal's life. That's according to the market, and I personally believe that as well. This is particularly true when it comes to end of life care. A hell of a lot of the expense of healthcare is within the last week or so of a human life. That problem doesn't exist with animals, because a mutual decision is agreed upon to put the dog (or whatever) down. We can't, and shouldn't, think that way with human beings. So, we're gonna pay more. Fine by me, as long as we're not getting gouged.

    •  In many cases (11+ / 0-)

      it would be both wise and merciful to withhold all the fancy,expensive treatment that only buys a few more days or weeks.  In some cases and with very tight controls I believe it would also be merciful to put people out of their misery if that has been the person's stated wish.

    •  In some cases, that last week of (6+ / 0-)

      expensive care is not only expensive, but unproductive, and possibly not in the patient's interest. We as a society would do well to really look that in the eye and decide.

      http://www.theatlantic.com/...

      Volandes nods. “Here’s the sad reality,” he says. “Physicians are good people. They want to do the right things. And yet all of us, behind closed doors, in the cafeteria, say, ‘Do you believe what we did to that patient? Do you believe what we put that patient through?’ Every single physician has stories. Not one. Lots of stories.

      “In the health-care debate, we’ve heard a lot about useless care, wasteful care, futile care. What we”—Volandes indicates himself and Davis—“have been struggling with is unwanted care. That’s far more concerning. That’s not avoidable care. That’s wrongful care. I think that’s the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time.”

      In 2009, my father was suffering from an advanced and untreatable neurological condition that would soon kill him. (I wrote about his decline in an article for this magazine in April 2010.) Eating, drinking, and walking were all difficult and dangerous for him. He ate, drank, and walked anyway, because doing his best to lead a normal life sustained his morale and slowed his decline. “Use it or lose it,” he often said. His strategy broke down calamitously when he agreed to be hospitalized for an MRI test. I can only liken his experience to an alien abduction. He was bundled into a bed, tied to tubes, and banned from walking without help or taking anything by mouth. No one asked him about what he wanted. After a few days, and a test that turned up nothing, he left the hospital no longer able to walk. Some weeks later, he managed to get back on his feet; unfortunately, by then he was only a few weeks from death. The episode had only one positive result. Disgusted and angry after his discharge from the hospital, my father turned to me and said, “I am never going back there.” (He never did.)
      This was expensive care, that lowered the quality of his life, that actually shortened his life, because we are not good at looking at the big picture. We are not good at considering that just walking into a hospital comes with a health risk, let alone the factors of immobilization and all the rest.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Thu Oct 03, 2013 at 09:17:00 AM PDT

      [ Parent ]

      •  It is a rare doctor who will be honest (1+ / 0-)
        Recommended by:
        TheDuckManCometh

        Doctors seem to find it hard to tell people when they are close to death and are likely not to live long.

        Come on, no one lives forever.

        Better discussions about that would avoid a lot of pain, heartache, and unnecessary expense.

        But maybe that last one is the problem.

        •  I'm not so sure about this. (0+ / 0-)

          Problem is the doctor does not know how you will react. If he says the reaper is close by and relatives do not believe that. His words can cause a frivolous law suit when patient dies cause relative think he did not try hard enough. The flip side is luck prevails and destiny is held back people they think the doctor is not very good.

          Talking is a lose, lose propitiation. Plus we have the opportunist greed factor.

          Straight talking folds into a few other issues too. NONE of which will change with ACA.

          •  Docs know the stats, and the signs (0+ / 0-)

            Signs of impending death are well known by medical personnel but not by most lay people.

            I hear what you are saying (yes there is sudden death, yes. there are miracle cures) but in most cases hospice manages this issue pretty well so no reason why run of the mill docs couldn't. They just are not trained to do so.

  •  There have been some very recent studies done (6+ / 0-)

    which I read about in NYT in which the gummint made an attempt at determining how much particular procedures cost. The difference in the cost of the same procedure from place to place was enormous, often five or even six figures, and in a number of cases, the snooty big city hospital was NOT the highest at all, but rather the smaller regional hospital with less competition.

    One of the things good old ACA does is look into these matters, in somewhat the same way they look into getting docs on electronic record keeping on standard programs, as part of figuring out what the reasonable cost of a procedure is and probably how to get there, rather than simply letting every separate doctor or hospital charge whatever suits them. The Rs call this rationing, rather than allowing folks to have some idea how much a given procedure should cost, when they will have to pay a percentage of it, and make choices before teh bills arrive, or are incurred.

    •  A little . . (1+ / 0-)
      Recommended by:
      Simul Iustus et Peccator

      The Rs are partially right.
      Rationing is when I "know" I will benefit from the test, drug, procedure and get refused it. Go to any health community forum on the internet. These are people helping each other work the system. You'll see rationing is being done already before ACA was a gleam in President Obama's eye.

      Don't confuse this with "thinking they "know" or Let's try this and see type thing.

      These are fine lines. The industry's problem is how to test and measure where that line is. A subject I've given Einstein type thinking to and have no answer.

      This line is fought over in every countries health care system. Currently the fight is between patient and insurance. ACA is moving the fight to between patient and government. So I ask which would you rather have a disagreement with?

      •  einstein thinking is not mush help (3+ / 0-)

        with out knowing much about health care systems and health care financing. (which doesn't mean insurance costs — it means the actual care.

        Actually somewhere around 95% of all medical treatments do not have adequate scientific evidence that supports their use. That doesn't mean they all don't work but that there is not good studies showing they are effective or the better way to do things.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Thu Oct 03, 2013 at 04:33:18 AM PDT

        [ Parent ]

    •  Not always true. Often the big "name brand" (1+ / 0-)
      Recommended by:
      Wee Mama

      hospitals charge a lot more and if an insurer objects they say fine, we won't take your insurance. Then the public raises hell and the insurer caves.

      Often the big hospital is great at fancy procedures but not so hot on the every day things. example: a lot of people want their babies born at Mass General or Brigham hospital in Boston but they are not as high on quality for births as almost all the smaller hospitals around.

      You can compare on many procedures on quality and cost. I think the Medicare site has some of the rankings. You can google hunt them down. Even some insurers have that info.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Thu Oct 03, 2013 at 04:27:32 AM PDT

      [ Parent ]

  •  Not every vet charges as modestly as your friend. (5+ / 0-)

    Large group practices with hospital and emergency service can -- and do -- offer the full area of medical technologies and treatments for animals, and the dollars add up quickly.

    My dog has been fighting an infection, origin unknown, since last Saturday. $3000 so far, and counting -- basically for nothing more than IV hydration and antibiotics, and three nights in the hospital.

    I wish I could sign my dog and cats up for Obamacare!

    Bo, Sunny -- please talk to Dad about this, 'kay??

    ;)

    •  This outlines one problem of medicine ... (1+ / 0-)
      Recommended by:
      Simul Iustus et Peccator

      You must really love that pet. My prayers for her.

      Infection of unknown origins very common. Procedure is to administer enough antibiotic to kill you. OK, fine going to die either way might as well try the way with better chances.

      BUT did the doctor order a culture? I'm guessing no. Cultures take up to 3 days to be read. By then 99% of cases are on the path to being cured. But that 1%, Oh boy, they sure wish they had ordered one.

      You see, with a culture you "know" exactly what you are battling. Allowing for precision targeting instead of carpet bombing.   See the dilemma? See the court case?

      The other thing is doctors are slow..  did I say slow? I mean like almost never drain the infection area. Think how much faster that infection healed on your finger once you soaked and drained it.

      I'm suppose to call him a doctor? Not doing a basic procedure. Excuse me while I go burn this soapbox.

      •  I should add . . (0+ / 0-)

        Cultures are going the way of the dinosaur with DNA. Much faster. Just as cheap as cultures. Problems is initial outlay for equipment and doctor inertia to order one.

        The good clinic will build this into the system whenever you go in for cold, infection symptoms. Like throat cultures and that little yellow cup.

  •  Another point is the overhead. Most stories I've (4+ / 0-)

    heard, and my personal experience with, the doctors offices and health care providers has to do with the incredible overhead to process all the claims, look over what they can deny, look over what they can upcharge for, and the doctors are paying salaries that don't have anything to do with actually providing health care, but the salaries go towards the people that help them process all the insurance paperwork.  The insurers also have plenty of overhead to allow them to deny your case multiple times and route you around so far you wind up giving up on trying to get your treatment approved so the insurer can save money.

    Your vet runs a very tight ship.  He sounds like he's got everything as parsimonious as he can, so he can keep bills low.  Doctors, health providers and insurers have built up a huge overhead monster that is resisting all attempts by the ACA and Consumer Financial Protection Agency to tame that beast.

    •  Doctors have been very inefficient (4+ / 0-)

      since forever. There is no excuse for not computerizing records and al lot of office type procedures yet most have to be bribed to do it. (Federal government subsidies and grants.) Yet there is plenty of evidence that it improves care.

      I think insurers have fucked up their system for denials but often they are trying to prevent ineffective and less successful and often dangerous treatment. There are non-monetary costs that have to be factored in.

      Some day I will finish my diary on this with cites and examples.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Thu Oct 03, 2013 at 04:41:04 AM PDT

      [ Parent ]

      •  I was a part of electronic records.. (3+ / 0-)

        being first used in offices. There are a lot of things I'm critical about with medical industry. Electronic records is not one of them. I believe you are not understanding the complexity of computerizing medical people. I'm not disagreeing with you, I'm quite sure you can cite examples and organizations. I just believe in this case being harsh about record keeping is ignoring to many of the human factors of what it takes to use something different when you have been trained and using another totally different way.

        If your on the insurance side I would love to read what you have to say. I've always thought insurance people had this list made up by a doctor they hired to routinely reject requests just to see how many bounced back where they would then let most go through.

        We are just entering the 2nd generation of people who grew up on computers. I have yet to see a doctor handle a computer with same ease as his office workers. Unless the doctor grew up with computers I do not expect to see her at ease with one.

        The software and hardware industry had to reach a certain level of maturity to enter the medical office. IMHO that happened with XP on a duel core.

        I myself being in the computer field find it surprising these two factors have a huge amount of inertial weight.

        •  good tablets are really what will make them work (1+ / 0-)
          Recommended by:
          ColoTim

          Powerful laptops with digital x-ray machines are an essential part of it too.

          Computerized records didn't help much when the computer could not come to the patient, or when half the records were hardcopy because that's how they were made.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Thu Oct 03, 2013 at 09:21:59 AM PDT

          [ Parent ]

          •  I LOVE digital x-ray and CT! (0+ / 0-)

            I have a copy of every one done on me on my home pc. Sometimes instead of playing a game I go look at myself ;-) and try to see what they see. I learned it is not easy to read x-rays. The software they have to use sucks big time too.

            I'm really hoping ACA does not end up making more paperwork to get the copy.

        •  3d generation in our family! (0+ / 0-)

          We were precocious, computer-wise. In fact I once had a job title of "Junior Computer." And we had one of the first Apples.

    •  Something like 30% (1+ / 0-)
      Recommended by:
      ColoTim

      I've heard that something like 30% of our health care dollars go to administration and profit.

  •  I am sure you know this but for those who don't (4+ / 0-)

    it is actually very common for vets to stitch themselves or each other up if they get a cut that needs stitches.  Especially since the procedure is identical for both animals and humans except that most people don't have enough body hair that you need to shave the area first.

    You have watched Faux News, now lose 2d10 SAN.

    by Throw The Bums Out on Thu Oct 03, 2013 at 12:06:02 AM PDT

  •  More Manderings . . (1+ / 0-)
    Recommended by:
    Ender

    Give's Simul Iustus et PeccatorFollow, Christy1947 a cigar. Oh, wait, make that a candy cigar. grrr, ok a high five then. Praxical, Arguing the 99% number would be fun. In general I agree though.

    The following are just continued random thoughts.
    I might add if we didn't sue doctors to oblivion so often because schooling did not weed them out properly. But we are short of doctors and ACA is going to make that much much worse for at least the next 12 years minimum.

    Or allowing hospitals to be profit centers instead of a utility. I'm willing to bet a decade or so ACA will make them like managed like utilities

    Or having military grade requirements and testing on medical equipment and tools.

    Or liberal's trying to protect addicts from themselves.
    (thus making drugs not available over the counter)
    [btw allowing farmers to use antibiotics negates the argument you are thinking of right now]

    Cristy1947 is right. In the beginning, lets say pre-antibiotics the gap of knowledge between general public and people with medical science was huge, enormous. Today it is less true. it is however still very wide, I cite vaccine, Scientology, Stem Cell and ergot procedures as examples. Is it hard to understand why doctors stoled the powers they have? They had to just to get things done. Does that mean we should let them keep it? I vote no. If they figure out near immortality before we cut them to size they win. Which I expect to happen in next 50-75 years tops, next 20 would not surprise me either.

    I think the new class of physician assistant with prescribing power will actually make general health care easier to get. This will do more then ACA itself and it was a trend already started before ACA.

    A GP doctor requires 6 years of schooling.
    A specialist surgeon requires 8 years.
    A general surgeon requires 10 years.

    Our biggest fault is thinking life is valuable.
    Mother Nature says otherwise.

    To backup the last sentence. Mother Nature wanted me dead at age 6 months. Our freedom of choice found a way to produce a drug that has kept destiny awaiting entered the market about the time I was born. (yes, I was what is now considered an FDA round one trial recipient). I was not expected to see age 5, at age 5 I was not expected to see age 13, at 13 I was called a miracle, at age 57 I'm ancient medical news. I still use that drug from time to time.  (not insulin or DEA regulated)

    It gets harder to get a prescription for it every year. The very few doctors who do know my case still do not understand the 50+ year implications. The average GP is totally lost despite knowing the name and generalities about my type of case.

    I owe society for medical costs an amount more then . . . More then I'll ever be able to figure out. I question everyday is, was my costs worth it? My general answer is no.

    Steve Jobs has contributed more to society then we'll ever be able to figure out. He ignored freedom of choice when destiny first came a calling. Society lost a real visionary early. (wired magazine article).

    Stephen Hawkings is the only person I know of who has managed to truly balance his enormous medical costs with society.

    There are some levels of wisdom I'll never grok.

    We use freedom of choice to try and avoid destiny. Destiny always wins.

    •  Huh? (4+ / 0-)
      Recommended by:
      Wee Mama, Sparhawk, JerryNA, bobtmn

      re Jobs: " He ignored freedom of choice when destiny first came a calling. "

      He died early when he decided against standard medical care for a curable cancer and spent a year fucking around with nutricals and bio—scams and all the woo woo stuff he could find. Didn't work and the cancer advanced.

      So he choose to shop around where a new pancreas would be most available and found an area, Tenn or KY I think. He bought a $300k house to be his residence so that he was "local" and got on a short list. As soon as he got his new pancreas he sold the house back for the same cost (dealing there?) and went back home.

      Too late, cancer advanced. At that point the fanciest medical care couldn't stop it.

      Choice he had — more than we because of all that money — and choice he took.

      He gave a friend some advice as his time was running out: if you get cancer or something serious, don't mess around. Go get real medical care.

      Here in NM chiropractor are trying to get law passed to allow them to prescribe their approved list of drugs based on their 2 week or so "advanced training" that they design and supervise. This for a crock that says all your troubles are from a misaligned spine.

      Now they want to be qualified as Primary care doctors and they have submitted and are pushing a law so saying.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Thu Oct 03, 2013 at 04:56:33 AM PDT

      [ Parent ]

      •  yup (0+ / 0-)

        It's my understanding Jobs procrastinated getting treatment when first diagnosed. Going the herbal route as you say, to me, these are both freedom of choice.

      •  Just say no to chiropractors (1+ / 0-)
        Recommended by:
        bobtmn

        There is no reason to ever see one.

        (-5.50,-6.67): Left Libertarian
        Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

        by Sparhawk on Thu Oct 03, 2013 at 09:40:56 AM PDT

        [ Parent ]

        •  Why chiro works (2+ / 0-)

          Chiro works mostly by enhancing the placebo effect.   People who see chiro's are willing to suspend their normal requirements for evidence because the visit makes them feel good.   The most important thing chiros, and their young massage assistants, do is to spend time actually touching the patient.    This makes the person feel validated and cared for, which goes a long way towards feeling better.

      •  Had some background in medical devices (0+ / 0-)

        And so had acquaintance with top docs. All said the same thing: "If you have something bad, go straight to the best."

        •  My questions are . . (0+ / 0-)

          How to find the best?
          We all can't see the best. Dr does not have the time.
          How to tell we need to see the best?
          Then pray he's located in your city.
          Will ACA help answer these? I think not.

          •  Libraries are free. Research helps. (0+ / 0-)

            The internet is sometimes useful and also available at the library. If you can't do such research, seek out a friend or relative. Sometimes a call to your local medical association can be helpful. Most metro areas have a "top docs" list published in the newspaper or a local magazine on an annual basis.

            I'm not suggesting it is something your own doc will just hand you. But is it not impossible to find the information. You can often get ratings of hospital results by illness category from the state or feds.

      •  You have quite a few facts wrong. Jobs got a (0+ / 0-)

        liver transplant, not a pancreas transplant.  Cancer patients don't get pancreas transplants.  

        And he had pancreatic cancer, which isn't a "curable cancer."  Best case scenario is living a few more years; most will die within the next few months.  

    •  Buy a big barrel of the drug and stash it away (0+ / 0-)

      Then you won't have to worry about it again.

      If you can get the chemical formula, you can put it on the Internet and ask somebody to make it for you.

      Are you sure that the big pharmaceutical company didn't stop making the drug because they found something that works better?

      •  They still make it. (0+ / 0-)

        It is an essential component of your body. I deleted 4 paragraphs of side issues with the drug. Suffice to say I understand the why's of the system and ACA will not cure any of these problems.

  •  I just had a hysterectomy too. Looking at the #s (7+ / 0-)

    I see that my doctor had to bill $4500 for strictly the operating alone, just in order to get the insurance co to pay him $1500. Then I saw that the hospital managed to bill insurance over $19,000 even though I was told they would call it 23 hours and not run into next day charges...so yes, there are  million stories out there, and they are charging hundreds of times more than a single tylenol actually costs so they can cover their overhead. This all has to just stop.
    Single-Payer NOW!!!
    Then admin won't have to pay an advertising & PR dept.

    We are all pupils in the eyes of God.

    by nuclear winter solstice on Thu Oct 03, 2013 at 05:00:43 AM PDT

    •  I'll try to puzzle this for you. (1+ / 0-)
      Recommended by:
      nuclear winter solstice

      What they say, what they do, what they bill are three different things. In general a doctor does something. He writes the something down. That paper goes to medical coding. These people associate what the doctor wrote to a procedural code that insurance company wants for their computers. There is an entire sub industry that standardizes this. Insurance companies pick what they want to use. Basically they go with whats published.

      A code is suppose to contain everything about what was done like supplies, doctor time, nurses times, equipment use, etc.

      Everyone has their code they bill. Hospital has one, each doctor involved has one for time. the treatment procedure has one for supplies. It's like leggo on steroids. mix and match.

      Whenever you read about an HMO having legal troubles with billing. I'm willing to bet most cases are not intentional. The system just makes it easy to screw up when audited. If a govt agency or insurance wants to get some dollars back all they need to do is an audit. They are not going to find zero errors. It's the nature of the beast.

      Billing vs actual payment amount is a self serving beast unto itself. It started out with insurance companies doing a survey of a procedure's cost in the area they serve. They then decide what they will really pay based on whatever formula they use on the set of figures. This amount is what the doctor, hospitals got no matter what they have billed. Insurance does the survey on some whatever cycle. If your large enough you can negotiate outside this system.

      This is one big reason why HMOs came into being and why HMOs want you to use their network. As mentioned in another comment to this diary HMOs and insurance are the same beast. It is a hospital acting as an insurance company.

      A non HMO doctor gets stuck with the survey routine. This is why over time you do not see private practice doctors any more. It is much easier to work for an HMO. I think you can see the nastyness here.

      What really pisses me off is the network knows what it's income is from premiums, how much it costs to operate, how much and where the traffic will probably be.
      Any uninsured needing to use it's services is frosting on this cake. Charging the uninsured the published (high) prices instead of the formula (lower) priced would not put the hospital out of business.

      Now there is what I call a critical mass issue. Think any one doctor is only able to do so much work before having to hire another doctor. You do not want to hire one unless you can guarantee enough business to at least break even. This is a problem inherent to All businesses not just medical. So to many uninsured coming in at once could be a problem. Truth is I do not think it is a real problem except in rare cases.

      •  been there, saw it all happen: (1+ / 0-)
        Recommended by:
        BearCan

        I was a medical secretary in the late'80s/early '90s. I understand all about HMOs and coding. And anyone who pays a co-pay after already having paid a premium for the service has bought the bullshit hook, line, & sinker. I was there when they invented the concept.
             Why did they do it? Because the original HMOs were sold on the idea that anyone could go see their personal doctor any time for anything without having to pay at the door. So easy, so nice, no money exchanged. It was great. For one season. The problem, they found, was that people used it! Fancy that! So in order to discourage the moms from bringing in all three sick kids instead of just the sickest one, they decided a token amount of money would remind them not to do that. Just $2, such a tiny amount and even if two kids came it was still under a 5 dollar bill. But that didn't work because we were always either making small change, or putting it on the bill they weren't supposed to have, and yet they still kept coming. So the token was raised to a higher amount 5, then 10, then 20, then whatever the hell they are asking for now, which pretty much adds up to paying by the hour for the tiny amount of time the doctor actually spends talking with you.
             Now I work with the Dewey Decimal System instead. Same way of finding things but not so stressful.

        We are all pupils in the eyes of God.

        by nuclear winter solstice on Thu Oct 03, 2013 at 11:26:53 AM PDT

        [ Parent ]

  •  Hey, folks. Sorry I disappeared after posting. (2+ / 0-)
    Recommended by:
    JerryNA, BearCan

    My intertubes service broke.

    Great comments.  Made me think of "And another thing!"  It is common to complain about how prices are jacked up because doctors order unnecessary tests.  The conventional wisdom is they do it either because they are paid by the procedure (and are gougers) or because they are covering their asses (and are victims).  How 'bout this: Test away!  And then charge a realistic amount.  An MRI is not run on gold nuggets.  It does not really cost the system $10K to do it.  And then when they are called on the price gouging the hospitals cry about all the times they had to give away free $10k MRIs to the charity cases.  No. No. No.  They gave away a $500 MRI and called it a $10k loss.  And then charged everybody else more to make up the gouge.
    Doc does an Xray.  He says it costs him $40.  How much does the hospital say an Xray costs? I know, I know, you have to have a radiologist and a technician and an orderly and pay for the machine.  But that still does not account for the charges they say it incurs.
    If the tests do harm -- like too many Xrays -- then limit it.  But to tell us the reason you shouldn't do tests is because it costs too many thousands is sheer unadulterated bull shit.

    Arguing with idiots is like playing chess with a pigeon. As good as I am, the bird is going to shit on the board and strut around like it won anyway. –jbou (2013)

    by Simul Iustus et Peccator on Thu Oct 03, 2013 at 07:47:06 AM PDT

    •  If you look at other countries, (2+ / 0-)

      MRIs are way way cheaper.

      http://www.npr.org/...

      CHANA JOFFE-WALT: You've heard this story before. A guy goes into the hospital with a problem - weeks later, sits with a shocking bill, shaking his head.

      Professor HOWARD FORMAN (Diagnostic Radiology, Yale University): That's the MRI of a lumbar spine - with total charges submitted by the hospital: $2,352.96 cents. Aetna had a negotiated rate of $1,731 just for an MRI of the lumbar spine, which is a fairly routine study. It's a lot of money.

      JOFFE-WALT: Typical story, right? But listen to who this guy is.

      Prof. FORMAN: Howard Forman. I am a professor of diagnostic radiology and also of management, also of public health, and also of economics at Yale University.

      JOFFE-WALT: A radiologist, a public health specialist and health care economist, who was shocked, decades into his career, to find out how much an MRI costs. Okay, test, test. If you just tell me your name and your title?

      JOFFE-WALT: A comparison: Professor Yekagami, also a health care economist, although he is in Japan. And he has had many, many MRIs. And do you know how much a MRI cost in Japan?

      Prof. YEKAGAMI: Hundred and sixty dollars.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Thu Oct 03, 2013 at 09:28:46 AM PDT

      [ Parent ]

  •  We are lucky: small town (0+ / 0-)

    We are lucky to live in a small town with about 4 GPs, family doctors.

    You always see the same doctor. It's easy to get an appointment. An office visit is about $60. The drugstore is across the street from several of the docs. They will call the prescription over so it is ready when you walk in. The doctor, nurse and pharmacist all know your name and ask about your kids and your dog.

    Spoiled, this is so much like the old days.

  •  I remember back in the 90s (0+ / 0-)

    I had a nasty infection that required antibiotics.  Around the same time, my dog had a need for antibiotics.  One evening as I was giving Bogart his pill I noticed how similar it looked to my own.  I got one out of each bottle and compared them side by side.  Identical.  In dosage, color, type, size and every other way except price.  The people version -- even as a generic -- as at least 10x the doggie version.

    I don't know this for sure, but I suspect that the additional inspections and paperwork and controls that are applied to people meds account for at least some of the difference.  But still.

    I'll believe corporations are people when one comes home from Afghanistan in a body bag.

    by mojo11 on Thu Oct 03, 2013 at 02:00:46 PM PDT

    •  Yup Yup! (0+ / 0-)

      The FDA put a stop to being able to buy antibiotic in the pet section years ago just cause of what you described Mojo. Yet they still allow farm animals wholesale injections. ACA will not stop this.

      Lately the CDC has been making a lot of noise about superbugs. Makes me wonder what's really up?

      •  There was actually a whole segment of 60 Minutes (0+ / 0-)

        devoted to that exact situation back in... the 80s I think.  Exact same medication and a fraction of the cost.  I always assumed it was that one was regulated by the FDA and the other by the USDA, but if it's the same stuff from the same manufacturer... and who knows, it may go through the exact same production facility... just these pills go down this chute, and those go down the other for packaging.

        I worked with a dog rescue several years back and we could get our own vaccines and do our own shots. All we had to do was fill out a form and affix the label from the vial to it and it was as good as if a vet did it.  I don't think there was even any licensing required.  Try THAT with people meds.

        I'll believe corporations are people when one comes home from Afghanistan in a body bag.

        by mojo11 on Fri Oct 04, 2013 at 06:05:37 AM PDT

        [ Parent ]

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