5186

I wouldn’t class independent contractors as employees, but never mind. The data don’t show that:

Where is your source on this? Beyond your own personal experience, I mean? Personal experience is good, I’m not knocking it, but you were wrong about most doctors once already.

Edit: Note that my source allows doctors to decide whether to respond as owners or employees. It seems unlikely to me that employee doctors with inconsequential ownership stakes would self-identify as owners instead, but I admit the possibility.

5187

After my wife’s stroke, she had to wear a heart monitor for 30 days. The heart monitor consisted of some leads, a small box she wore around her neck, and a cheapo Android phone it communicated with via bluetooth. All of this stuff looked like it was 6+ years old. At the end of the 30 days, the device and phone was to be returned.

The cost of that 30-day rental was $7500. She found what looked to be the exact same device on Amazon for like 120 bucks.

5188

Need I bring in Martin Shkrelli or the EpiPen?

Also yikes!

And that’s the problem. You do not have the ability to price shop in that situation. You’re stuck with what they give you. Which allows such usurious rates.

5189

The lowest paid doctor is not on that list.

After all doctors graduate medical school, they must spend 4-8 years in a job that pays less than Amazon does. Doctors cannot earn more than that until they are well over 30.

5190

That is not… what Medicare for all is. That’s just addresses the insurance. You know that right?

5191

Yes, of course. I’m repeating this:

…on the assumption that you missed it earlier. Rural hospitals are not being close by Medicare rates. They’re being closed because they don’t have a customer base adequate to keeping them open. This is why health care as a market service fails. It ought to be the job of government to keep those hospitals open with public funding.

5192

Yes, exactly, and they prey on people when they’re their most vulnerable. The doctors had no idea what caused my wife’s stroke at the time, so there was major worry that another could hit at any time. One of the things they needed to rule out required the heart monitor, which we basically had to pick up immediately after leaving the hospital. It was only later when she returned the device and got the bill that we realized we had just been screwed out of $7,500 for the month rental.

5193

You don’t now that they are failing their communities, we just know the health systems are unable to remain profitable enough to remain open. You keep switching terms and ideas like they’re interchangeable. You don’t know that a health system that closes its doors somehow failed the community it operated in when it comes to services. It could be that the community is small, is primarily Medicare and Medicaid, and neither of those two cover costs. In addition, one bad season, one bad year, heck one particularly expensive outlier case can sink a healthcare system floating on the line.

I am not aware of a candidate that has promised much more then doing public insurance which would still not be enough to keep these systems going. The rural idea is probably not what people are thinking either… because rural in healthcare isn’t exactly what most people are thinking, it doesn’t just mean out in the middle of nowhere. Rural hospitals already get different pay rates, in many circumstances, to try and accommodate the need to offer services to a small population, but it’s not quite right.

5194

I don’t know what that means. Somewhere upthread you blamed Medicare reimbursement rates for closing rural hospitals. I doubt the connection between the two, and think it is more likely that those hospitals aren’t viable because they 1) lack sufficient paying customers and 2) aren’t adequately subsidized by public health funding. This is an entirely different subject than Medicare for All, but we are talking about it because you brought it up. Not me.

5195

If you want government to provide more funding, then you need them to provide more money per patient. That’s the opposite of arguing that the government could easily cut costs.

5196

Sure, but you don’t have to use Medicare to do that. You could just fund public hospitals that bill standard Medicare rates and make up the difference with subsidies. The point is that you don’t need those subsidies in every market.

It isn’t, because they aren’t the same cost problem.

5197

That is not what I said.

You don’t seem to appreciate complexity of the healthcare systems. You keep talking about the industry like it’s just raining money and profits are everywhere so just cut into that and viola, magic. Cut salaries, cut profits meanwhile… systems are literally closing

Providers are not slaves. You cannot force them to work. Not all systems are raking in profits. The government payors don’t cover costs. This doesn’t have to do with what I am bringing up. This has do with over simplistic idea you keep bringing-up and then brushing away any criticism when it’s pointed out how ridiculous those approaches are when you actually look at it beyond some politician soundbite.

5198

I mean you can’t even legitimately shop around and price compare for something routine and with a long planning cycle.

Having a baby.

Its something on a 9 month timer, where you know within a few week window when it happens. It is not unusual, particularly risky, or difficult to deal with. Yet I defy you to find out how much it will cost. Hospitals straight up won’t even tell you often. And even if they did say some costs, they won’t mention things like how they bill $30 for some advil, or $1500 for the anesthesiologist which is actually not in your insurance network because fuck you. Or the various little add on things that are part of the routine procedure, but the hospital gets more money by coding separately and in exoctic means in an attempt to extract more money from insurance and you.

So if you can figure out, within a few thousand, what that will cost? You’re doing good. And that is a best case scenario!

5199

Then the misunderstanding is surely mine, but I can’t find any other obvious way to understand this:

What is the connection between the first sentence and the second one here? I assumed the one was intended as the cause of the other, but that must not be right.

5200

Looks like it averages around 7.5k a year, but some specialties like surgeons cost upwards of $50k a year for malpractice insurance.

https://howmuch.net/costs/medical-malpractice-insurance

5201

It’s not right. I did not actually say rural hospitals are shutting down because Medicaid and Medicare don’t cover costs. I am repeating facts you keep ignoring.

You seem to think all these health-systems are raining profits and doctors and all you have to do is cut and bam, problem solved. I am saying that is not true.

5202

Ok, but what does it mean? Why connect Medicare and Medicaid to closing rural health systems if you don’t intend to connect them somehow? I’m genuinely confused.

5203

Do you know what a Payor Mix is?

5204

I do.

5205

This distinction between fixed costs and variable costs you bring up is extremely germane to the discussion. Sadly some people are missing it.

Saying the public should ensure that rural hospitals remain open is not incompatible with saying reimbursement rates are for sone things too high. And in fact we also know many rural hospitals in red states closed because their state did not take medicare expansion.

The problem is not ‘it costs $2000 to take an X-ray at a rural hospital’ the problem is it costs $x00,000 a month to keep said hospital open even with zero patients. The marginal cost of that x-ray shouldn’t be higher, but rather we need to directly address the overhead. Because the medicare rate is not per hospital, so raising the rates to keep a rural practice open has huge negative impacts across the system.

Better to have a reasonable rate and directly deal with the overhead and operational costs separately.