Time: Bitter Pill: Why Medical Bills Are Killing Us

[NoCalMike]

Are folks lazy to some extent? Sure. I wouldn't disagree, but I also think the population are being "poisoned" by some of the big food manufacturers.

It's also high questionable when you have board members hopping back and forth from the committees who regulate the food to the ones who regulate the medicine and back, then back again.

I think technology by nature has probably made us a less active society as far as "exercise" goes, but when I use the term exercise, I am not talking about taking an extra 2-3 hours out of the day to do it. I'd say 30-50 years ago, people were more active out of necessity, it wasn't necessarily because they were better or smarter about their health, it was because that is how it had to be done back then. As technology advances and more things become automated, it's just a matter of fact that many things that required an active lifestyle 50 years ago, don't anymore.

The problem is so complex.

[Special K]

Shown during cartoons. Encourage kids to pressure their parents about healthy lifestyle, unless they want to be destitute orphans. :evilg:

Hellooooo, those would infringe on the airtime of junk food and toy commercials! I've been babysitting my 5y/o niece quite a bit and as a result, have been exposed to the crap commercials aired on Nickelodeon, Cartoon Network, etc. I can't count how many millions of junk food and toy items this kid has added to Auntie's "shopping list" as a result of these commercials So hey, if even a minimally positive outcome could come out of encouraging kids to place pressure on their parents to engage in fun, healthy activities with them or buy health food items that appeal to the kids, I'm all for it. I'm willing to look into anything at this point! I wish so much we had the money to mount these types of PSA campaigns and just inundate America with with healthy messages Like tobacco, maybe if we start taxing all this junk food, that revenue can be used in preventive efforts...

[gbear]

I see a lot of taxes proposed for things like sugary junk food and sodas. If we are going to go this route, and I don't think it's a bad idea, I would prefer a tax on salt content. If you go after salt content, you go after processed foods. If you take on that portion of our diets, I suspect the rest is taken care of as a by product.

On the incentive side, I know BCBS has offered a pedometer to my wife and I every year. Seeing how much you walk or run is encouraging. Incentives for maintaining or improving a body fat percentage could also help.

[PeterMP]

Peter,

On my phone, so I'll try to be brief.

1. On GDR vs GSR, I remember the issue but can't recall the details. I will try to look it up tomorrow, mostly because I think the distinction doesn't actually favor Medicaid.

2. The law was passed in December 2003. Plans had to hire staff, negotiate pharmacy networks, negotiate rebates and formulary design. Write and submit bids to CMS in June of 2005. That's like 20 months, max, and plan bids all came in under projections. The pipeline didn't dry up in 20 months. Prices were lower because of competition.

I've honestly only seen one other poster here that was so clueless on a topic insist that they really had any clue on the topic.

It is given in the link I've already posted:

"For Part D, the overall single-source drug-prescribing rate of 37 percent is similar to the median single-source drug-prescribing rate of 41 percent for State Medicaid programs during 2004."

And

"For Part D, the overall generic drug utilization rate of 56 percent is similar to the median generic drug utilization rate of 54 percent for State Medicaid programs during 2004."

The numbers are similar is what they concluded, but more importantly even if the numbers aren't similar its really irrelevant at the level of a prescription drug benefit.

It might suggest that there is something else in Medicare that is helping people not get diseases where they don't have the option of using a generic or possibly that Pharma is going out of there way to develope new drugs that are relevant to the Medicaid population more specifically (possibly not because they are on Medicaid, but because they are more likely to have characteristic X), or it might be a difference between the two populations that is simply inherent in them being different (e.g. environmental pollution issues related to differences in where they live based on their income.)

The most meaningful number is the substition rate, and they are very similar (1% a part) for the numbers we seem to have.

The initial CBO estimate was created in 2003 and so there are years in between where the estimate was done and people really started spending on drugs.

But it is even worse than that, in making its estimate the CBO didn't use 2003 data, they used older data for prescription drug use.

http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/44xx/doc4468/hr1s1.pdf

"The model contains detailed information about beneficiaries’ spending for prescription drugs and Medicare-covered services, their supplemental insurance coverage both public and private), their health status, and their income.2 CBO’s estimates of Medicare costs result from the operation of that model.3"

"The estimates are based on data from Medicare claims for 1999 and from the 2000 Medicare Current Beneficiary Survey,

projected forward using CBO’s March 2003 economic assumptions and baseline projections of Medicare spending.

3. For more general information about CBO’s prescription drug estimates, see Issues in Designing a Prescription Drug Benefit

for Medicare (CBO Study: October 2002).

8"

They used data from the height of the patent protection of the commonly used drugs (1999 and 2000) associated prices and inflation of costs to do their estimate.

Now, it was clear in 2003 when they did their estimate that there was PROBABLY going to be down turn (from 2000 there is a clear trend of a decrease in FDA granted exclusitivity, but at that point in time, it was only a 3 year trend, but at that point in time it was pretty clear that the large scale combinatorial chemistry approach for discovering drugs had failed so the pipeline was going to be down for a while), but they used the older data (probably because that's what they had in terms of real numbers (It has also seems to me that they more regularly over estimate costs/under estimate savings by using older data that it appeared wouldn't hold true they ensured they didn't underestimate costs)).

And then in 2005, the CBO actually up-dated their estimate, but in terms of drug prices and usage, they still went back and used the older data.

If in 2006, you would have used 1999/2000 data to estimate the drug costs of the US, even excluding Part D participants, you would have been wrong.

And there was "competition" before Part D. People were making generics. People were using generics. There were drug stores and insurance companies trying to cut as good as deals as possible to make more money for themselves or to recruit customers.

It isn't like there was no or even low prescription drug use prior to Part D.

You don't get to conclude because X was lower it was lower because of Y reason. How was the estimate done, what year did the data come from, etc?

What did they anticipate that the generic substitution rate would be and why?

When you do the estimate is irrelevant if you are using old data to do the estimate.

[China]

I see a lot of taxes proposed for things like sugary junk food and sodas. If we are going to go this route, and I don't think it's a bad idea, I would prefer a tax on salt content. If you go after salt content, you go after processed foods. If you take on that portion of our diets, I suspect the rest is taken care of as a by product.

Processed foods? How about artificially sweetened milk:

Artificial Sweeteners in Milk?

Got diet milk? In a highly controversial move, the dairy industry wants to market artificially sweetened milk—without any special label to alert consumers.

In a petition filed with the FDA, the International Dairy Foods Association (IDFA) and the National Milk Producers Federation (NMPF) seek to change the definition of “milk” so that chemical sweeteners like aspartame and sucralose can be used as optional ingredients not listed on the product label.

If the petition—originally filed in 2009 and now under consideration by the FDA—is successful, these hidden additives could also be included in 17 other dairy products—including whipping cream, low-fat and non-fat yogurt, eggnog, sweetened condensed milk, sour cream, and half-and-half—without requiring any special labeling.

The dairy industry contends that using artificial sweeteners like aspartame as optional ingredients in milk and other dairy foods without any special labeling would “promote more healthy eating” and boost kid appeal. Currently, milk consumption is dropping among both children and adults.

Click on the link for the full article

[PeterMP]

Processed foods? How about artificially sweetened milk:

Artificial Sweeteners in Milk?

Good grief this is crazy.

I'd like to suggest that everybody goes to the page where you can comment against this. Less information on our food is not the solution to this problem and doesn't support a long term real world studies of what health affects different things have.

Here's the page where you can comment:

http://www.regulations.gov/#!home;tab=search

[Wrong Direction]

I've honestly only seen one other poster here that was so clueless on a topic insist that they really had any clue on the topic.

So the OIG report had three methods that disfavored Part D, and a one more that just wasn't accounted for.

1. They used data from the first two quarters of 2006. Not sure whether or not you recall, but the first 6 months of 2006 were mayhem for Part D. Enrollment data lagged significantly and CMS granted waivers to states for continued coverage of dual eligibles. Once enrollment records caught up to systems, beneficiaries received a 3-month transition period allowing them to continue use of existing therapies regardless of formulary placement. Even after the 3-month transition, those beneficiaries with later effective dates still received a similar transition period. The net effect of this was the lowest GDR and GSR Part D ever saw.

2. By virtue of Part D inheriting 100% of its population, and the fact that the population was able to choose a plan based on their existing drug use, shifting to generics was further stunted at implementation. This trend stabilizes as new versus ongoing enrollment trends wash out.

3. Multi-source brands were not included. The reason from OIG is clear, but based off of a definition that was written to tie formulary rules to FDA processes, not to measure the competitive nature of the benefits. The reason this matters is because Medicaid's very low cost sharing limits the beneficiary incentive to choose cheaper options, whereas CMS data showed that the GDR went up a few % based on inclusion of multi-source brands. You'll note that this report on GDR was released showing data from Q4 2006-Q3 2007 for Medicaid. It includes Multi-Source Brand drugs because that definition is more noteworthy. http://www.reducedrugprices.org/documents/StateSavings082008.pdf

4. Part D, obviously, does not cover drugs paid for by Part B or Part A. I'm guessing this helps make up the difference between single source prescription rates, but I really don't know.

You can see Part D GDRs over time at this link: http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html. If you combine with the link in #3 above, you get the closest thing to comparability, and Medicaid is roughly 1% behind Medicare.

Perhaps most important to the entire discussion is the difference between a mandate and a market. In Part D, consumer choice is the rule of the day. They are not mandated to use generics like they are in Medicaid and they still achieve at least comparable use. That's a powerful statement by itself.

The initial CBO estimate was created in 2003 and so there are years in between where the estimate was done and people really started spending on drugs.

…

If in 2006, you would have used 1999/2000 data to estimate the drug costs of the US, even excluding Part D participants, you would have been wrong.

…

And there was "competition" before Part D. People were making non-generics. People were using non-generics. There were drug stores and insurance companies trying to cut as good as deals as possible to make more money for themselves or to recruit customers.

I’ve done some looking but am not going to take the time to get fully into the CBO methods. There were a ton of trends that nobody could have really predicted. While NDAs are lower, BLAs were highest between 2000-2004, before a falloff in 2005/6. There were huge generic entries around that timeframe, but that was predictable. Tiered formularies were growing and politicians began to see the savings in generics, so there were multiple trends driving their use. Pharmacy networks also allowed plans to lower pharmacy reimbursement relative to AWP (or WAC/whatever) and lower dispensing fees. I have no idea if CBO also assumed something like an AWP-10% average price versus what the market is now bearing (much lower discounts off of list price than in 2006). Competition did exist beforehand, but on something like GDR for example, the benefit structures in Part D far outpaced GDRs for other private plans.

The dynamics are plentiful, so I’m not sure what to tell you. There are a ton of consumer-driven choices being made in a program with much lower premiums than predicted (from day 1 to present) and extremely high satisfaction rates. There are also some not-exactly correctly anticipated by CBO dynamics, but those almost certainly have items that add and subtract from the balance sheet. If you want to believe that lower direct enrollment (driven by the law itself) and somewhat lower NDA issues drive the full story, go ahead and believe that.

[Special K]

Processed foods? How about artificially sweetened milk:

Artificial Sweeteners in Milk?

Got diet milk? In a highly controversial move, the dairy industry wants to market artificially sweetened milk—without any special label to alert consumers.

In a petition filed with the FDA, the International Dairy Foods Association (IDFA) and the National Milk Producers Federation (NMPF) seek to change the definition of “milk” so that chemical sweeteners like aspartame and sucralose can be used as optional ingredients not listed on the product label.

If the petition—originally filed in 2009 and now under consideration by the FDA—is successful, these hidden additives could also be included in 17 other dairy products—including whipping cream, low-fat and non-fat yogurt, eggnog, sweetened condensed milk, sour cream, and half-and-half—without requiring any special labeling.

The dairy industry contends that using artificial sweeteners like aspartame as optional ingredients in milk and other dairy foods without any special labeling would “promote more healthy eating” and boost kid appeal. Currently, milk consumption is dropping among both children and adults.

Click on the link for the full article

Unbelievable. All the more reason to stay away from dairy products, or at least cut out as much as possible.

[PeterMP]

1. They used data from the first two quarters of 2006. Not sure whether or not you recall, but the first 6 months of 2006 were mayhem for Part D. Enrollment data lagged significantly and CMS granted waivers to states for continued coverage of dual eligibles. Once enrollment records caught up to systems, beneficiaries received a 3-month transition period allowing them to continue use of existing therapies regardless of formulary placement. Even after the 3-month transition, those beneficiaries with later effective dates still received a similar transition period. The net effect of this was the lowest GDR and GSR Part D ever saw.

Are you sure that's what caused the effect?

Maybe what has caused the increase in GDR amongst Part D users is the samething that has caused the increase in GDR amongst the general public and that is more commonly used drugs becoming availible because of expirations of patents (and I'll point out this trend PRECEDES the implementation of Part D).

Again, you want to assign a complex reason for something happening when a much more simple explanation is availible.

Yes, it is possible that you are right, and maybe it isn't all one thing or the other, but when a smaller set of the population is showing the same trend as the entire population there's no real reason w/o evidence to assign a special cause to the smaller part of the population.

Perhaps most important to the entire discussion is the difference between a mandate and a market. In Part D, consumer choice is the rule of the day. They are not mandated to use generics like they are in Medicaid and they still achieve at least comparable use. That's a powerful statement by itself.

The fact of the matter is that many (and maybe even most) though actually assume that the free market is not achieveing "comparable" results, but superior results.

There's plenty of comments on here like 'I don't want the government running healthcare. Have you been to a DMV recently.'

But when you look at something like this, if there's a difference, it isn't much (and when you look at the reductions the Medicaid gets Medicaid is doing really well compared to Part D).

And that's all in the context of the FDA that assures a certain level of quality, which makes education by the public to ensure they are getting a qualilty product relatively minimal, which isn't seen with respect to the other aspects of health care (essentially the public ONLY has to know about price to make a good decision with respect to drugs because of the FDA at the level we are talking about here). The samething isn't true in terms of the doctor, hosiptial, medical tests, and "non-medical" decisions that actually end up affecting their health and their healthcare.

Competition did exist beforehand, but on something like GDR for example, the benefit structures in Part D far outpaced GDRs for other private plans.

But that doesn't mean it was caused by the competitive nature of part D.

That's the whole problem here. You want to say X is true and it must be caused by the competitive part of Part D.

I'll bet people in Part D are more likely members of the AARP then people in private plans too.

The cause must be the nature of the competitive nature of the design of Part D (I mean it couldn't have anything to do with the non-competitive part natures of part D, like the mandatory age requirements).

If you want to believe that lower direct enrollment (driven by the law itself) and somewhat lower NDA issues drive the full story, go ahead and believe that.

I believe what the evidence supports. The evidence supports that Part D has been cheaper than what was expected because of the decline in the increase in pharmaceutical prices as compared to the values used to predict the costs of the CBO.

I think I've pretty robustly demonstrated that in this thread.

[Wrong Direction]

I believe what the evidence supports. The evidence supports that Part D has been cheaper than what was expected because of the decline in the increase in pharmaceutical prices as compared to the values used to predict the costs of the CBO.

I think I've pretty robustly demonstrated that in this thread.

There are a lot of words in this thread, so maybe I missed it. But where did you quantify this? I understand their assumptions were off, but did you quantify what effect that change in assumptions had on the overall baseline beyond "it made them estimate high?" Maybe it's in one of the CBO links...not sure. Did it take into account the increase in specialty drug prices? This should be fairly easy to back out, I'm just not sure if it's been done.

Even if accepted without reservation, you're point about the benefit being below the CBO score is a political one if anything. It says nothing about the good and bad of Part D.

Regardless of the CBO score, which is an argument inside of an argument, my basic premise was that 1) lobbying is the biggest danger in healthcare and 2) competition and transparency can lower prices. In the context of the bitter pill argument, I see no reason why that's wrong and frankly no reason why I read CMS' response to an OIG report about generic drug utilization rates in this thread. C'est la vie.

[PeterMP]

There are a lot of words in this thread, so maybe I missed it. But where did you quantify this? I understand their assumptions were off, but did you quantify what effect that change in assumptions had on the overall baseline beyond "it made them estimate high?" Maybe it's in one of the CBO links...not sure. Did it take into account the increase in specialty drug prices? This should be fairly easy to back out, I'm just not sure if it's been done.

Even if accepted without reservation, you're point about the benefit being below the CBO score is a political one if anything. It says nothing about the good and bad of Part D.

I don't know anywhere anybody has done a hard quanitation.

We know the CBO estimate is high. We know that when the CBO did its estimate it used data when people were using more non-generic drugs in that period of time there was higher drug inflation rate. We know since then many drugs have come off patent and the rate and importance of drugs covered by patents has decreased.

We know in the general public that has decreased the rate of the inflation of drug use because of increased generic use and that trend pre-dates the creation of Plan D.

We know that trend also is appearant in Plan D and has continued in the Plan D population and the larger population after plan D.

It's evidence, not quantiative proof.

I don't see how an increase over what was expected to happen would cause a decrease. If anything, that would indicate that the change in something else (e.g. the use and availibility of generics) was even more dramatic then expected.

Regardless of the CBO score, which is an argument inside of an argument, my basic premise was that 1) lobbying is the biggest danger in healthcare and 2) competition and transparency can lower prices. In the context of the bitter pill argument, I see no reason why that's wrong and frankly no reason why I read CMS' response to an OIG report about generic drug utilization rates in this thread. C'est la vie.

1. Might be true irregardless of what direction you want to go in. Many people that want to see much more government involvement believe the samething so that's not an argument for any particular action.

2. There's no real reason to believe that's really true. Medicaid, which is pretty much anti-competition and free market in its approach, achieves similar generic usage (especially subsititions) and better discounts.

And that's in the limiting system where there is already massive regulation by the FDA that tries to achieve a certain level quality making costs really the primary concern for consumers at the level we are talking about (none of this is touching on do the people really need to be taking the prescrisbed drug).

If we think of an individual person going to a doctor, and the doctor says they need X test and its going to costs $500 and they shouldn't take no test, but also shouldn't take Y test that costs $5,000, there is no well regulated system that really assures that doctor is making a good decision and so quality of the test isn't an issue.

There's plenty of reason to believe that a free market won't succeed with our health care system as currently structured because of the inability of people to make good decisions (now, if you say we're going to change our healthcare system so that the federal government liscenses doctors in a robust manner (e.g. goes through their charts and determines if they are using affective treatments and deliscensing those that don't.), maybe that changes.)

[NoCalMike]

I don't want to necessarily equate GMO's with healthy/non-healthy, but hell out here in CA in the last election, mandatory labeling of GMO foods was on the ballot and the pro-side was leading most of the race until the usual "interest groups" dump a ton of money into the other side of the issue with a couple weeks to go so once they gain the majority, it is difficult for the other side to get any momentum back.

Keep in mind, this wasn't a bill to say really anything negative on the GMO packaging, just inform folks that what they were buying was either GMO or not, yet people were scared by the "OMG putting a GMO sticker on food will make your food prices go up by 200%" BS line.

This was simply more information for the consumer. Forget the GMO aspect, but I find this troubling in the bigger picture that people didn't feel having more information at their disposal about the food stocked on the shelves the buy food for their children would be a good idea.

I sometimes wonder if people really do just think ignorance is bliss and are willing to just be in the dark about what they put into their bodies as long as the price is cheap, until the damage is done beyond repair and they are content to live out the rest of their lives on multiple prescriptions.

Now we are getting stories that there is horsemeat being used in "beef" in a lot more cases than we think and a lot of the "fish" being served at restaurants and grocery stores is not really the type of fish being advertised on the package or on the menu.

[PeterMP]

I don't want to necessarily equate GMO's with healthy/non-healthy, but hell out here in CA in the last election, mandatory labeling of GMO foods was on the ballot and the pro-side was leading most of the race until the usual "interest groups" dump a ton of money into the other side of the issue with a couple weeks to go so once they gain the majority, it is difficult for the other side to get any momentum back.

Keep in mind, this wasn't a bill to say really anything negative on the GMO packaging, just inform folks that what they were buying was either GMO or not, yet people were scared by the "OMG putting a GMO sticker on food will make your food prices go up by 200%" BS line.

This was simply more information for the consumer. Forget the GMO aspect, but I find this troubling in the bigger picture that people didn't feel having more information at their disposal about the food stocked on the shelves the buy food for their children would be a good idea.

I sometimes wonder if people really do just think ignorance is bliss and are willing to just be in the dark about what they put into their bodies as long as the price is cheap, until the damage is done beyond repair and they are content to live out the rest of their lives on multiple prescriptions.

Now we are getting stories that there is horsemeat being used in "beef" in a lot more cases than we think and a lot of the "fish" being served at restaurants and grocery stores is not really the type of fish being advertised on the package or on the menu.

The GMO issue is more complex because of issues with cross contamination.

I can buy my grain from a farmer that isn't trying to grow a GMO. I can use it to make crackers and put a non-GMO sticker on it.

Somebody buys it in the grocery store and does a test and comes up positive for a GMO.

The farmer was really not trying to grow a GMO, but his field had become contaminated. Who do you penalize?

And its easy to say that the vendor should test the stock, but there isn't a single test for every GMO. They'd have to do a test for every method to produce a GMO (I don't know how many that would be, but it certainly will increase with time too), and there might not be enough information in the public domain to even do the test (the information might be protected by patents).

It seems to me you are most likely either looking at a law that is meaningless because it won't have any real enforcement/penalty, everybody (even people not trying to use a GMO) end up putting a GMO sticker on it just to legally cover their butt, or they are going to end up doing a bunch of tests of every batch of flour/grain they buy, which would probably kill the organic/non-GMO market.

It might be possible to construct a good and meaningful law, but it would be difficult.

I think intentionally adding artificial sweetner to milk products is a little more straight forward.

[NoCalMike]

I definitely agree that the GMO issue is complex and cross-contamination introduces a gray area into the situation, however I also think if people had that information in front of their face, it would leave to more questions being asked like "why can't I find anything non-GMO" which would maybe eventually lead to lawsuits being filed and won by the other side for a change.

I agree about the artificial sweetener in milk, and let me ask why is this being done?

I don't know ANYONE who said (at least out loud), "Ya know this MILK stuff is decent but making it sweeter would really hit the spot" How about you? Anyone?

Something tells me that extensive testing is being done and they are either concluding that A) there is some type of addictive elements to these cheap sweeteners being uses or B)They are trying to get these sweeteners into our systems without us knowing so our bodies and brains will build an artificial crave for them more leading to our will power to stay away from all the garbage we know has sweetener stuff in it, powerless.

[Elessar78]

Podcast from Marketplace Money. It's a segment where the "author" was bit by his cat and the sticker price for all his treatment was $53,000. Obviously, he doesn't pay for it all out of pocket because he has insurance but the segment works with an health care industry insider to decipher the costs.

http://www.marketplace.org/topics/economy/health-care/53000-cat-bite-you-gotta-be-kitten-me

[Bonez3]

Podcast from Marketplace Money. It's a segment where the "author" was bit by his cat and the sticker price for all his treatment was $53,000. Obviously, he doesn't pay for it all out of pocket because he has insurance but the segment works with an health care industry insider to decipher the costs.

http://www.marketplace.org/topics/economy/health-care/53000-cat-bite-you-gotta-be-kitten-me

Good highlight on high costs and how hospitals 'eat' remaining balance because an insurance company does good business with them.

However, the title would make you think a cat bat is benign. Far from it, and in fact it would appear by the bill the author had a not uncommon sequelae of a cat bite.

Cats have sharper teeth and often can cause a more dangerous wound than most animals. Further, an infection of the tendons or even bone is not uncommon either. Many requiring orthopedic surgery to avoid further potential complications, possibly even leading to amputation.

This guy had MRI to diagnose his deeper seeded infection, than required likely intricate hand or foot surgery. His bill actually would be justified if you compare that to the car he drives or the cost of losing function of the limb operated on as related to his job. Frankly, I think it's a cheap bill for nearly a week stay in a hospital and surgery/anesthesia/medicine.

[Special K]

Good highlight on high costs and how hospitals 'eat' remaining balance because an insurance company does good business with them.

However, the title would make you think a cat bat is benign. Far from it, and in fact it would appear by the bill the author had a not uncommon sequelae of a cat bite.

Cats have sharper teeth and often can cause a more dangerous wound than most animals. Further, an infection of the tendons or even bone is not uncommon either. Many requiring orthopedic surgery to avoid further potential complications, possibly even leading to amputation.

This guy had MRI to diagnose his deeper seeded infection, than required likely intricate hand or foot surgery. His bill actually would be justified if you compare that to the car he drives or the cost of losing function of the limb operated on as related to his job. Frankly, I think it's a cheap bill for nearly a week stay in a hospital and surgery/anesthesia/medicine.

I second this.

People underestimate the potential danger from cat bites. When I worked for my father who is an ortho, I remember being somewhat surprised when he discussed cat vs. dog bites. He said the exact same thing as you in regards to shape of cat teeth and higher likelihood of osteomyelitis from these bites as compared to other animals.

I knew there was a legitimate reason I hate cats.

[rictus58]

back on 3-9-13, I had to take my daughter to the ER. She fell outside and split her nostril in 1/2. I paid a $75 co-pay at the time of visit. Friday, I get a bill for a $75 copay for the Doctor who stitched her up. So now I have to pay that too. Apparently the Dr and the hospital each charge their own copay. Why not just get it done all at once?

[#BgMase76#]

Here's a fun fact. We're the only one of the 32 OED countries that allow pharma to advertise. Why, because everyone else understands that medicine is a necessity not a business venture.

[gbear]

I was looking for where best to place this, and this seemed reasonable.  (Side note: The article inspiring this thread also answers Kilmer's question from earlier this summer about the $13k MRI bill).

 

http://finance.yahoo.com/news/apnewsbreak-early-look-health-laws-181912365.html

 

There is now some information on premiums under the new healthcare law.  At first glance, the rates seem surprisingly low.  I'm not saying they will be pain free for everyone, but I expected higher.

[Mad Mike]

Part of the problem is the healthcare industry is a racket.

The other part is insurance is a racket.

Another is medical supplies and pharmaceutical companies are a racket.

The last part is, Americans seem to go to the doctor for every little thing. Clogging up ERs with lame ass sicknesses. Clogging up hospital beds when they aren't warranted. My wife gets on me because when I get a cold, get sick or have an ache/pain, I don't immediately run to the doctor. I don't want to spend my life in ERs and urgent care centers. I want to be healthy.

We also have the mentality that we can get a "disability" for anything. I saw that in my previous job as a patient advocate who would sign patients without insurance up for programs. It clogs up the SS system when people want a "check" with their bad backs and trick knees. It ruins it for the people who really need the assistance and who are truly disabled.

 

I was with you till the last two paragraphs.

 

Emergency rooms get hit not because people are going about some "lame ass sickness" but because of a health care system that makes the emergency room the only way to receive treatment if you cant afford insurance and a regular doctor for preventative care.

 

And your comments about SS are total BS. I have a bad heart, permanent nerve damage in my left leg from a series of spinal injuries and after two dbl fusions. My hips and knees are shot and I STILL cant get SS. You act like they give it out to anyone with a bruise.

[NoCalMike]

Yeah, if you have good health insurance, then you tend to go to your family dr or local office for pre-cautionary reasons, even if whatever you are experience turns out to be no big deal.

 

The way the system is setup though is that the uninsured have no place to go other than the ER and often for things that if treated sooner wouldn't have been a big deal.

 

Example, if you are older and have high blood pressure, cholesterol etc etc etc.....ideally you are going to your Dr once every few months if nothing more than to do the blood labs and acting accordingly. Possibly getting prescriptions.

 

If you aren't insured, and can't afford those Dr. visits and blood labs, then you probably have no idea what is going on until you are feeling so awful that your body is wrecking you due to those symptoms.

[pjfootballer]

I was with you till the last two paragraphs.

 

Emergency rooms get hit not because people are going about some "lame ass sickness" but because of a health care system that makes the emergency room the only way to receive treatment if you cant afford insurance and a regular doctor for preventative care.

 

And your comments about SS are total BS. I have a bad heart, permanent nerve damage in my left leg from a series of spinal injuries and after two dbl fusions. My hips and knees are shot and I STILL cant get SS. You act like they give it out to anyone with a bruise.

Wow, what a bump.  I had forgotten about this.

 

I worked as a patient advocate for 10 years with Tenet Healthcare.  My job was to interview the uninsured to see if they would qualify for assistance with their medical bills.

 

Our advocates that worked in the ER, advised their patients to try and see a regular doctor or go to the Urgent Care center.  The words ER mean- "Emergency Room."  Having a cold and runny nose is not an emergency, yet according to our advocates in the ER, 80% of all patients that showed up at our ER did not have an actual "emergency."  Of course the system sucks.  I've been on both sides of it.  I have a finger that cost me $6,000 out of pocket when I broke it and had no insurance back in 1999.  I had to make payments before and after the surgery.

 

I worked closely with the SS Office in my area and they said that 7 out of 10 applications for disability did not meet the requirements and the people who truely had a disability and needed the disability, their cases were getting bogged down because of a backlog of cases that were never going to be approved as they didn't meet the criteria.  They do have cases that they called "tery" cases for those that had a disability that could be deemed terminal.  Those were expidited. If you have a legitimate case, you will be approved.  But you have to have medical evidence to back it up.  It usually takes about 2 to 3 years for a disability to go through.  I never said they give it to just anyone.  It's the backlog of the cases that don't meet the requirements that slow down the process for those who meet the requirements. Hell, if they just gave it to anyone, it would have made my job a hellava lot easier and I wouldn't have complained.

 

I'm sorry, but believe it or not, there ARE people out there with fraudulent claims of disability.  If you don't believe it, then you are being rather nieve.  There really ARE people that just want a check. I'm not saying you are one of them and if you keep getting turned down, keep appealling.  Eventually your case will go before a judge and I've rarely seen a judge deny once it gets to that level.  Good luck.  I hope things turn out good for you.  I was always happy when one of my patients were approved because it was my decision to persue the disability that helped him/her. 

[pjfootballer]

Hospitals get pressure to get their patients out from the insurance companies.  That puts pressure on the doctor to "cure" them and get them out of the door.  Hence, the doctor has not done a full workup on the patient and taken the time to get them well, so you have a bunch of readmissions.  Alot of readmissions is on the insurance company. 

 

Another thing about insurance companies.  They don't want to pay for alot of preventative maintenance costs when the patient is healthy, young and not in need of medical care.  Other countries have a better PM plan.  With a good PM plan, insurance companies should realize that it lowers their costs down the road when the patient is older and more prone to have problems.  So, they deny simple PM procedures in "hopes" that the patient won't get sick or maybe to push costs later down the road to maximize profits now.  We have one of the poorest PM plans in this country.

[NoCalMike]

I don't think anyone is saying there is no fraud taking place, but that will usually happen in any and every system no matter what, people will find ways to try and take advantage.

Hospitals get pressure to get their patients out from the insurance companies.  That puts pressure on the doctor to "cure" them and get them out of the door.  Hence, the doctor has not done a full workup on the patient and taken the time to get them well, so you have a bunch of readmissions.  Alot of readmissions is on the insurance company. 

 

Another thing about insurance companies.  They don't want to pay for alot of preventative maintenance costs when the patient is healthy, young and not in need of medical care.  Other countries have a better PM plan.  With a good PM plan, insurance companies should realize that it lowers their costs down the road when the patient is older and more prone to have problems.  So, they deny simple PM procedures in "hopes" that the patient won't get sick or maybe to push costs later down the road to maximize profits now.  We have one of the poorest PM plans in this country.

 

Deny routine PM care, and drop them completely when something that costs a ton comes up later simply because they don't want to cover it.