My wife went into insurance coding several years ago, it was supposed to be the next big thing, with experienced coders making $40+ per hour and working from home. Well, some do that, but the last company she worked for was subbing the work out to companies overseas. Locally inexperienced coders might make $16 an hour.
Oh, I know all about dealing with mis-coded claims. Having to deal with that issue recently.
Family favorite: A procedure for my mother-in-law was coded as a prostate exam.
My last doctor used to code his own stuff in the examining room after giving you a physical. That was pretty weird.
Coding is a strange and specialized thing. People who are good at it, and do the âhardâ stuff are paid pretty well. Some hospitals hire off the street for coding the âeasyâ stuff. I recently heard of an ex co-worker who was doing that. I can only imagine the quality of her work.
My current doctor now does this. I need to get procedure codes for him and the diagnosis code, and go on to my insurerâs website to ensure it is listed as a covered service.
uggh.
The coders in the physician offices and the inpatient codes in a hospital setting are entirely different beats. One has a shortage, the other is heavily pushed to go offshore, and some of the ones overseas cannot gets their certification due to limits on giving those to oversea entities.
The mess weâre in now is largely self-inflicted. Abuses were done, fraud committed and now we have all these weirdo requirements originally designed to catch that but is largely done to help insurance companies get out of paying.
I like that article because goes over many of the cost drivers that explain why US health care is so expensive. Administrative cost add an extra 5%, I believe Iâve used that same figure. But in the context of $10K per person health care cost that is only $500. Not nothing but not a silver bullet. Prescription drugs $1400 vs $700-$900 for the rest of the developed world definitely a factor but not THE factor. Higher salaries for Doctor and nurses another contributing factor. More expensive equipment, catscans , MRI, more individual monitoring stations. Then we get into patient amenities, we have a lot more private and semi-private rooms which also means more equipment. The sad truth is we canât wave a magic wand e.g. âmedicare for allâ and drive health cost down to anything approaching the rest of the world any time soon.
It is going to be a hard process, and while even those in the medical field agree something needs to be done. There is no way it is not going to similar to taxes. âdo not tax you, donât tax me, tax the fellow behind the tree.â
I think you might be reading that wrong. Itâs costing 8% of our GDP and they spend 1-3% of theirs. 8% of the USA GDP in administrative costs for healthcare is absurd. Thatâs 8% of 18 trillion dollars, or 1.4 trillion in administrative costs. Thatâs about 5k per person in the USA per year. Thatâs 20k for my family of 4. Thereâs a big part of the runaway healthcare costs - for profit insurance working hard to not pay your claims for healthcare.
Iâm pretty sure that figure it is BS. Although, one of the biggest issue with health care in the US is the complete lack of transparency so who really knows. But when I sanity check it doesnât make sense.
The best estimate I found is that insurance company collect about $1 trillion in premiums. (Approximately 1/3 of 3.4 trillion we spend is from Uncle Sam and many large companies self insure). If we look at the largest insurance company United Health Care it had 201 billion in revenue in 2017 and it paid out it $154B in payments to providers. (That number under estimates the pay outs because United Health has a HMO which is more than 1/3 of the revenue). So the administrative cost is the difference between 201-154 or $47 billion. United Health Cares pay ration actually corresponds quite well to the ACA rules which requires that 80% of all premium collected be paid out as benefits. Of the $47 billion in gross profit, United Healthcare made a $15 billion in profits and the rest is admin cost. (Total insurance company profits are about $250-300/person even if we cap all salaries at $1 million/year) Now there is certainly admin cost on the part of doctors but I donât think it is anywhere near the cost that would get to $1.5 trillion. Unless, you include a far broad definition of admin cost, janitors, receptions, cafeteria workers etc. In a link free article is pretty much impossible to know
Most estimates Iâve seen of Social Security put the admin cost at 3-4% and health insurance companies at 7-9% of the total health care cost, not GDP. Hence my comments.
There is a theory that giving the government power to negotiate things would drop costs significantly. Which is basically what other countries do and why a drug costs like 50 times as much in America as it does in say Denmark.
Now Iâm sure that wouldnât be enough, but I think most people would be willing to see a tax increase if it meant not paying for health insurance, which for a lot of people is getting to be more expensive than their mortgage if they want to actually ever use it.
I mean Iâve talked to Aussies who are insanely conservative. They have hidden guns on their property and arenât fans of the âAbosâ. Theyâre not big on homosexuals. Theyâre not big on government regulation for the most part. They fucking love their nationalized healthcare.
âItâs not free we fucking paid into it our whole lives. Why canât you Americans sort it out? Are you fucking stupid?â
One thing to think about on the issue of health care reform reducing prices: no other county has actually reduced prices; the best they have done is hold the rate of health care increase to the rate of inflation. You can roughly track the percentage of GDP a developed country spends on health care with the era when they adopted government price reform in health care. If they adopted early, they end up with health care at a low percentage of GDP, 5% or 6% (like Great Britain, although I believe part of that low cost is that the British NHS is on the penurious side). If they adopted somewhat later, they end with costs somewhere in the 8% to 12% of GDP range (Canada, France, Germany). If they just kept slamming their head against he wall of inelastic demand til now, they are paying almost 18% of GDP (yeah, guess who.)
Basically, there are a lot of sunk costs, issues of path dependency and the fact that humans are âstickyâ about their incomes all of which make it very hard to actively reduce the revenue of an industry like health care. However, government price reform has successfully held the rate of health care price increase to the general rate of inflation (rather than 2X or 3X inflation like we chumps have) in many countries.
So, yeah, in theory, government price reform (which I strongly support) could lower prices, but in the big picture I think thatâs a big ask. I would settle for reigning in the unsustainable and crushing growth, and not look for any magic ponies of cost saving falling from the sky. As Strollen said, health care reform is hard. Despite that, itâs still worth doing. Actually, itâs not just âworthâ doing; we must reform health care further in this country or the temporary reprieve provided by the ACA is going to get overwhelmed by the continued insanity of double or treble inflation price hikes, increasing costs to employers and individuals, and general health care suckitude.
My current favorite proposal remains some form of âMedicare Buy Inâ (which is not exactly the same as âMedicare for Allâ as generally conceived.)
Must sleep now. I drove 900 work related miles today, appeared in court, and took a doctor deposition, and now my brain is like slow cooked oatmeal.
There is also a theory that the USA subsidizes these drugs which means if the USA stopped doing that, the cost to other countries should go up. Again, thatâs a theory, not proven.
I donât even know if itâs a theory or more just an excuse. The pharmaceuticals distribute into other markets because they make money at the negotiated price.
While Iâm sure their bottom line would be hit hard by sane pricing in the US, thatâs a feature and not a bug for me. Cost savings need to come from somewhere and thatâs a good place to start, as long as theyâre still profitable.
EDIT: This wasnât posted in disagreement or anything with you, Nesrie. I was just continuing off of your statement about the subsidization theory.
It would kill their US marketing teams. Do you hate jobs Kevin? Think of all those poor marketing people who no longer can make a living trying to convince people that their ennui can be solved with some Zoloft.
Liberals always trying to kill jobs through regulation, itâs frankly Un-American
I hate jobs and⌠checks notes⌠the little people. And Iâm talking about all you insignificant cogs, not people too short to ride the halberd.
(wow, that sounded a lot more dirty out loud than it did in my head)
Itâs perfectly okay to disagree with me, but youâre right. Presumably theyâre not losing money on each sale to the EU or other countries. They would not be eager to just cut their profits though, so they would presumably raise their prices elsewhere if they suddenly lost their cash cow is where I was going with that.
The marketing of these drugs just⌠I hate there are almost no limits on this.
Hey, it would be Un-American to try to prevent the drug companies from convincing me that I should nag my physician to prescribe a drug I donât need.
One thing to note about the drug price issue is that although itâs a big âin your faceâ cost to a lot of Americans, itâs actually not a huge fraction of the entire health care pie. My understanding is that when you look at the price differential between US and other developed countries, about 15-20% of the differential (in dollar terms) is in medications and DME, about 30-35% in hospital costs and around 50% in doctor costs (specialists, in particular).
People get hit with drug costs routinely and have to pay them directly in many cases, but they are a small amount per unit compared to the big ticket items (again, in dollar terms) like surgery and hospitalization.
Medication price reform is definitely something that would be politically popular, and would help the US health care system, but itâs a secondary issue compared to hospital costs and the cost of specialist MDs.
One of the Fâed up things about our system is that a lot of the cost occurs in specific circumstances like end of life and major injuries/illnesses while what most people see in their daily lives are less costly but still painfully expensive stuff like routine visits, diagnostic studies and medications. So most citizens perceive both the cost of health care and the cost-drivers of healthcare as being different from reality.
In terms of the price issue, in the US it really boils down to: we pay more than double other developed countries to go to the hospital and almost triple the other developed countries to see a specialist, and most of those costs occur when the patient is in pretty damn bad shape. The stuff that effects people on a more daily basis is actually a smaller piece of the pie, monetarily speaking.
Thatâs $100 Billion a year, just for marketing in the US for these companies.
They collectively spend 2/3 that amount on research.
And thatâs a very obvious disparity thatâs causing higher prices. What about shitstains like the people who bought the epi pen? It ainât even marketing, itâs striaght up buying legislators and jacking prices way up. Why market when you can buy law.