From a friend’s FB post, tried it and it’s true.
“Please call Washington. Paul Ryan is conducting an automated survey about the Affordable Care Act. Call him at 202-225-0600, press 2 at the prompt, listen to the partisan message, press 1 to indicate you support the ACA. Takes less than two minutes. (You Don’t actually talk to a person, just a machine)”
I tried it and never got any sort of message or prompt to press anything.
I hit 2 and it was all 'thanks for taking time for this survey, if you want to leave a message for Speaker Ryan stay on the line." I literally never gave any input at all. His voice mail is full though, so… that’s something.
I had to call a couple of times to actually get the recording going, just to note.
Hmm. I just tried three times and got nothing. Going to wait a few minutes and then try again.
If it doesn’t hang up on you, just stay on the line. I got silence for about a good solid minute or so before anything happened.
Yup, just worked!
Edit: And thanks for posting those instructions, by the way!
Thanks for the number! Totally called and hit 2 after that the message!
Obese patients have worse outcomes than regular patients for these operation for many reasons. One of those worse outcomes is the increase likelyhood of the replacement lasting for 20-30 years it may need to be replaced after only 15-20 because of the additional wear and tear due to the weight.
I’m not being critical of the Canadian/UK system (which are the ones I’m at least somewhat familiar with) just pointing out that it is harder to get what I would call quality of life operations in those countries than somebody with insurance in the US. This is just one of the many reasons US Healthcare is more expensive
So is the fact that US surgeon is going to make $300K vs 36K for a Spanish surgeon.
By population, total GDP, or total number of doctors, the EU should produce more medical innovations than US. I couldn’t find definitive data but from what I can tell that is far from the case. From what I could find the share of medical research spending by US no longer exceeds the rest of the world combined, it is now down to a mere 45%.
I’m not saying the Europe doesn’t provide some medical innovations they certainly do, but it is like military tech, the US provides more than 5-10 countries combined.
This drives up the price to the US consumers as explained here.
The focus on healthcare debate has been almost entirely on who pays and the process of paying. The theory I guess is if somehow we just figure the best way of paying the cost will somehow magically decrease. I think this if fundamentally wrong, the discussion we need to have should be focused on cost a lot more. How much is it worth to save a life, improve the quality of life, and extend the life of a senior citizen?. Once we figure out much we are willing to pay for healthcare then we can have intelligent discussion about who pays what.
Well in theory the two discussions are related. If we move to a single payer system where that party has the authority to say “We only pay for X things, and only Y dollars” then costs could be controlled. If not done carefully that could be to the detriment of all, obviously, so there’s plenty of disagreement as to who and how that kind of power ought to be wielded. I do think there’s general agreement at this point that someone needs to have that power that isn’t A.) medical providers who are happy to take all the money and do all the things and B.) insurance companies who value profit over a quality healthcare system.
You’re not wrong that this is a critical element in fixing the US healthcare system. Costs are absolutely out of control, and patients lack the leverage or knowledge to combat this.
But, as @Tortilla said, the two problems are intricately linked.
I mostly agree with you, but if this medical research is as cost effective as medical care (that is, very ineffective), this 45% of spending would lead to a much lower share of actual results.
If you look at this (http://www.efpia.eu/uploads/Modules/Documents/the-pharmaceutical-industry-in-figures-2016.pdf) you will see the US outspends Europe on Pharma R&D by about 50% (page 5) but only outproduces new chemicals by about 20% (page 8). While there are more US base innovations, it’s not a dramatic difference and R&D money seems to be (way) more inefficient in the US.
Moreover, most money spent by research companies in the US (pharma) is spent on marketing (per the article you link) and marketing is something you don’t have to do as extensively in single payer systems (because you negotiate with government actors, not necessarily the public).
There is a point to be made that what is driving the costs to the US consumer is not the expenses in medical research, but the expenses in marketing (because it’s higher than the expense in R&D and the difference in spending US vs EU is also bigger).
I did this, and then also called back to leave commentary about tax reform.
Instead, you get a message about Islamic terrorism, and the girl reading it screws up at one point, said, “dang it!” And then the recording ends. Lol
Well, add me to the ranks of the “Thanks for nothing, Obamacare!” people.
For the past two years I’ve reaped the benefits the ACA brought to my small company healthcare plans. I was able to move my family off the ridiculously useless High Deductible Healthcare Plan we were on for years (because it was all my company could afford to offer it’s employees) and take part in a Silver level Humana plan my company was able to secure in the exchanges thanks to ACA. For the past two years we’ve enjoyed reasonable co-pays and caps on healthcare spending that have saved me somewhere in the neighborhood of $6000 or more based on the needs we’ve had those two years. Noting catastrophic, just some tests for my wife during a possible cancer scare (they were negative, but may need to be repeated every few years) and some other, more mundane doctor visits. I’ve been a huge fan of the ACA for all this time thanks to the savings…
…which have now come to an end. Because the ACA added so many people to the rolls of insurance without doing anything to address the skyrocketing costs of healthcare or offsetting the burden these additional people put on insurers (because it’s cheaper for healthy single people to pay the penalty for non-coverage than to pay for coverage), my company just announced that our premiums to stay on the Silver plan will go up by over $400 a month (family coverage). My family budget sure as hell doesn’t have an extra $400 a month lying around unused right now, so it looks like my family will be heading back to the ranks of the HDHC catastrophic plan. It’s a simple choice really, pay the extra $5000 a year and maybe another $1000 or so on top of that for co-pays, or roll the dice and hope my family racks up less than $6000 in medical bills over the next 12 months.
This entire system is fucking worthless. Killing off the ACA won’t help anyone, but neither will reforming it. What’s needed is something that addresses the real underlying issues of healthcare in America, the outrageous costs. Not just the ridiculous amounts hospitals charge for ibuprofen or a CT scan, but the ridiculous costs of medical equipment, the ridiculous costs of mal-practice insurance, the ridiculous costs of learning to become a doctor/nurse/etc., and the entire ridiculous structure of how people are charged for healthcare based on location, insurance type, income levels, etc…
Basic healthcare for everyone, paid for by taxation, with costs fixed no matter who is being served. Then supplemental insurance, again with fixed costs. for those who want or require a higher standard of care or more advanced care. There is still a ton of money to be made in reasonable healthcare, we just need to find a path to common sense and service for everyone.
Sorry to hear that Slainte. I was pleasantly surprised to see that my grandfather in catastrophic coverage only went up from $178 to $187. The Silver is $400 and the ACA policy even more. The bad news about a catastrophic is I haven’t been to a doctor in 2 years, I haven’t been sick and the benefits of annual visit are debatable, but still I probably should go.
I agree with you the on problem and mostly agree on the solution. I don’t see any easy path forward.
A couple of months ago, I attended a presentation on investment opportunity regard MRI machine. the Dr giving the presentation was the chief of radiology at the top hospital in Hawaii, and his business partner was a former GE medical exec. So I assume their numbers are accurate. I started to do some calculation that I think might be interesting to the forum.
Total number of MRI machines in the world 25,000
US 15,000 Rest of the world 10,000
Average cost of MRI $10+ million
Average Age of 8 years
Average cost of MRI scan in US $2,600
Now $10 million is a lot of money so hospital try and keep them utilized. I figure 80 hours/week and the operating cost technicans, schedulers, a room, is $300-$600K/year
the total capitals cost of MRIs in the US is over $150 billion or about $500/person
The other 10,000 machine with a cost of $100 billion is spread over about 2 billion people (EU, Japan, and the upper middle class in the rest of the world) or about $50/person
Divide the number by the average life of 8 years and the US is spending about $60/person/year on MRI add in operating cost of 25-50% and $75-90/year of the $9500 we spend on health care is spent on this one device which the rest of the world spend 1/10 as much. I bet there are least a dozen machines like this and we have $1000 we spend per year on these machine vs $100 for ROW.
Now before MRI were available Dr. used X-rays googles say it cost on average $260-400 for X-ray in the US or 1/10 to 1/6 the cost.
Now by all accounts MRI are way way better than X-rays and they save lives. The problem is that most of the time when Dr. orders an MRI scan, he already has a pretty good idea of what is wrong from the X-Ray. Hell a good diagnostician like Dr. House doesn’t even need no stinking test! So a lot or MRI test move the doctors confidence from say 90% to 99% (Made up numbers) that $2300 add cost is an expensive way of upping the confidence level unless of course it is your or your love ones life on the line and then it is cheap.
Here is the real chicken and egg problems. Since the big cost of MRI is the capital cost in makes sense to utilize them as much as possible. With 15,000 MRI spread out over 5,600 hospital in the US that means that virtually all hospitals have one or more. Whereas there only 10,000 MRI for the remaining 65,000 hospital in the rest of the world meaning that vast majority don’t have them. If a US hospital suddenly says screw it we aren’t forking out $10 million for a new one that puts them at big competitive disadvantage vs other hospital. The best Dr aren’t going to work for hospitals without decent equipment.
This means (I’m speculating) that Juan’s dad when he does hip replacement probably doesn’t do a MRI, cause they just aren’t super available but it is relative common do to them in the US. Both my mom and her partner had one before their knee and hip replacements
But this is all needless worry, since I know Donald understand this and will replace obamacare with something that is great and saves us a lot of money.
[quote=“Strollen, post:334, topic:73916, full:true”]This means (I’m speculating) that Juan’s dad when he does hip replacement probably doesn’t do a MRI, cause they just aren’t super available but it is relative common do to them in the US. Both my mom and her partner had one before their knee and hip replacements
[/quote]
Nah, they are available (I got one 20 years ago due to some serious spinal issue), but they are reserved for when they really are needed. Serious conditions diagnosed with cheaper tests or conditions that can’t be diagnosed through X-rays (that was my case). This was on an 80k population city in the poorest region of the country, so there is no scarcity at all (there’s propitiation, though). My wife got one last year due to minor neck pain (in Madrid, she had to wait a week since it was prescribed).
If you are getting a hip replacement you do get MRI. No question.
It’s just that the protocol to get assigned one for minor issues is stricter. A protocol that, btw, is not government mandated, but left to the doctors discretion. Doctors don’t need to woo their patients so they don’t change hospitals, so they take a health first (as opossed to client first) approach. MRI’s, as well as othe tests, are considered to be counterproductive too early in a diagnosis. They might reveal too many asymptomatic issues that can muddle the diagnosis. Moreover, those asympthomatic issues are then treated, resulting many times in a reduced life expectancy or life quality of the patient.
I had back pain again a couple years ago. My mother (also a doctor) argued against an MRI on these grounds. My symptoms were not serious enough nor indicative of something more insidious to warrant a test that might have done more harm than good. I didn’t ask for it on her advise.
The problem you point out is real, but it’s not that other countries lack necessary equipment. It’s that the US system, due to being private and thus having conflicting priorities, overspends and over equips way, way beyond needs.
These figures are misleading. Hospitals use the equivalent of a random number generator to decide how much to charge for an MRI, but the only important number is what they are actually paid. The unpaid balance is written off (except for the rare patients who are paying out of pocket).
It’s hard to know what insurance companies pay, but they generally bargain for something similar to what Medicare decides to pay.
What Medicare pays is public knowledge, though it’s a little difficult to actually decipher.
First you determine the CPT code for the procedure. For unenhanced lumbar spine MRI, possibly the most common MRI study of all, the CPT code is 72148.
Then you can look up the reimbursement for that CPT code at cms.gov. This is typically broken down into technical and professional components, which go to the owner of the machine and the radiologist respectively. There are various modifiers depending on geography, inpatient vs outpatient, etc. Still, a rough estimate would be $200-$300 total. Figure $400-$600 for an enhanced brain MRI (70553), which is another very common exam with contrast injection driving up the payment. I would estimate that those two exams, by themselves, make up 25-50% of all MRI scans.
Chest xrays, among the most common xray studies, will generally be reimbursed under $50. Screening mammography (G0202), another very common xray, is reimbursed at $100-$200.
BTW, there are CPT codes for all procedures, not just radiology scans. Colonoscopy is 45378, botox injection is 64612, wart removal is 17110, etc.
There are still payors that pay based on percentage of charge, and not always a maximum. Healthcare systems don’t just base it on nothing as I’m sure you know.
You are right, what hospital charges varies tremendously but as Nesrie points out it is based to a large extent on cost, and then marked up a random amount :). So that’s why I think it is important to estimate the total cost to the system, it really doesn’t matter how much the hospital charges. It is the relative cost. As your figure indicate there is roughly a 5-10x increase in cost between and MRI and X-Rays. Since most of these cost is fixed there isn’t a hell of lot that can be done to drive done the costs.
Anyway I think I’m plus or minus 100% on the cost of MRI to the US and and the same range for the rest of the world.
First it is cool that both your parents are your doctors, I trying to learn this stuff by talking to people and google, but that’s no substitute the experience of your parents… I’m also not bashing the European system all the data seems to point out the Europe provides roughly equivalent health care to the US at roughly 1/2 the cost and in some cases even lower. I think you are spot on the analysis of the problem. It seems like a very hard problem to solve.
I imagine the culture of defensive medicine also plays a role in the over use of tests. “Doctor why didn’t you order an MRI,” I am sure what you say about them being counter productive is probably medically sound, but on the witness stands it sounds like because some evil organization was trying save pennies and look what happened. to my daughter cause they didn’t spring for an MRI.
Let me throw out the another wrinkle in the puzzle. The innovation pipeline. I have spent the last decade since I retired doing Angel investing. I typically invest in 2 or 3 companies a year, but I and my group typically look at 4-6/month.
Because, I have pretty good understanding of the game business and career in high tech I never invest in games, and seldom in software companies. The world doesn’t really need another social media app or Angry Birds clone. I have a soft spot (aka sucker) for medical start-ups eventhough I know very little about the field. A new stent, a smartphone blood analyzer, a better medical record system, a new cancer treatment, reformulating old drugs to treat different illness. a monitoring system to help with elder care, these all sound like classic making the world a better place inventions.
One of the commonality of almost all of these companies is their business plan involves make an equal or generally better product for roughly 1/2 the cost the existing products. They can does this despite typically marking up their product by 10 times. While they all talk about expanding into Europe and Japan it is clear that most of their money is going to be made in the US.
Increasingly the large pharma companies, and medical device companies acquire starts up, once they’ve shown some promise and have gone through the early stages of the FDA process. So the pitch they make to investors is we can sell to a Medtronics, or GE, or Abbot labs, or Bristol-Myers and you’ll make 10x in your money in 5 years.
The irony is in the last 10 year I’ve seen probably 100-150 presentation from medical starts-up from all over the US but to the best of my knowledge not a single one has return a single dime to an investor! Now, that maybe a bit extreme but from all the info I can gather almost no one is making money investing in medical start-up this century.
So if the US becomes more focused on healthcare cost, and hospital and doctors start being more cautious in buying that latest and great thing. What happens to the investment money for new ideas?
An MRI though can’t just cover itself. Procedures that raise or drive profits have to cover departments and patients that don’t. ERs typically lose money. They still have to be open. They still take anyone regardless of ability to pay, and to try and say you can only charge this much plus cost ignores the fact that that there are money making and money losing departments. When I say that, I am not referring to just overhead departments either.
That’s why the fear of forcing everyone to have insurance makes very little sense. If you pay for healthcare, if you have insurance, you’re already covering everyone else, but it’s not easily tracked, it’s not transparent. And that lack of transparency is not nefarious.Patient estimates are large and ongoing projects for a good portion of the industry. There are real attempts to provide accurate estimates to patients shopping around, but the fact of the matter is routine is only an adjective used until it’s not routine anymore. And some of the costs, like medications, implants, DMEs are mark-ups but whether a physician uses a 600 dollar screw or a 100 dollar screw is often up to the physician, not the healthcare system. Whether a specialist who is not employed by the healthcare system chooses to be “in network” for most insurances or “out of network” for most is often up to the physician. You can’t force a non-employee to sign a contract. And this isn’t to say the physician is at fault. There are reasons they’re not entering into contracts with these insurance companies.
It’s a complicate situation with no magic bullet, and give everyone insurance was never going to be the answer… but it was a starting point. Leaving out the mandate though was a terrible, bound to fail idea. The mandate had to be there and it had to have teeth to work.
Eh, but it’s a diagnostic tool. I mean, It’s kind of hard to say whether an MRI “is needed” unless it detects something… which in some cases you won’t know until you get the MRI.
All things being equal, I’d generally prefer the case where doctors could use it for testing on me whenever they feel the slightest need.
Of course, I realize that all things aren’t equal, and it costs money, so such decisions need to be made.