Obama: Healthcare debate is "over"

[retro]

Why are you willing to bet? You are intent on defending the status quo or just refusing to believe there could be some greedy doctors out there?

A close relative recently had a full hysterectomy in Texas, an operation that took over an hour and I believe the surgeon in that case charged about $3500 but I've not seen the bill yet. As far as complexity, I would think think the two operations I quoted are about the same in complexity, but there is a huge variance in the bills. If I'm wrong about this I'll report back and update.

I'm willing to bet because I've been very involved in medical billing, so it's an area of some expertise for me, although it's been about 9 years since I did that. Like nova said, Texas has enacted some of the best tort reform laws in the country, thus lowering the malpractice insurance cost, thus allowing the doctor to charge less for a surgery, or whatever other service they're performing. I don't know if that's the case, but it certainly is a possibility. Like I also said, there can be a big difference for different services, some doctors make their bill large, knowing full well that they're not going to be reimbursed anything close to that. The cost can also depend on the complexity, the potential liability involved, the cost of the physician's malpractice insurance, the expertise and experience of the physician, and the list goes on.

 

[Minor Axis]

I'm willing to bet because I've been very involved in medical billing, so it's an area of some expertise for me, although it's been about 9 years since I did that. Like nova said, Texas has enacted some of the best tort reform laws in the country, thus lowering the malpractice insurance cost, thus allowing the doctor to charge less for a surgery, or whatever other service they're performing. I don't know if that's the case, but it certainly is a possibility. Like I also said, there can be a big difference for different services, some doctors make their bill large, knowing full well that they're not going to be reimbursed anything close to that. The cost can also depend on the complexity, the potential liability involved, the cost of the physician's malpractice insurance, the expertise and experience of the physician, and the list goes on.

I have always been an advocate of tort reform.

You seem to be more than happy to dictate what is "excessive pay" for other professions, so I propose we do the same with you next.

I quote 2 similar operations where one charges 500% more than the other and this is your reply? :smiley24:

 

[nova]

ROFL. I just heard a sound clip where Wolf Blitzer got some balls with an admin rep. He asked them why there were talking "competition, competition, competition" but no one was considering point #5 from my plan.

It was quite funny watching the incompetent admin flunky try and dance around that one. :24:

I quote 2 similar operations where one charges 500% more than the other and this is your reply? :smiley24:

A. Since you're not a surgeon I dare say you have niether the information on each individual case, nor the expertise to say they were similar if you did.

B. Yes it is my reply. You're claiming what someone else charges for their services is excessive. If thats ok for one group, then its ok for all. Whats good for the goose is good for the gander after all. If you don't want people claiming what you charge is excessive, its probably a good idea not to go claiming anyone else's charges are excessive.

 

[retro]

I have always been an advocate of tort reform.

good on you then

I quote 2 similar operations where one charges 500% more than the other and this is your reply? :smiley24:

You've only provided anecdotal evidence about supposed costs of surgeries, we don't know what those surgeries are past one being a gall bladder surgery and one being a hysterectomy. For all we know, there were complications with the gall bladder surgery, special equipment used, etc. We also don't know what type of gall bladder surgery was performed. Was it laproscopic? Was it a removal? There are any number of factors involved here. The gallbladder surgery bill could've included pre and post-op care. In addition, a gall bladder surgery and a hysterectomy aren't "similar operations".

 

[Minor Axis]

good on you then



You've only provided anecdotal evidence about supposed costs of surgeries, we don't know what those surgeries are past one being a gall bladder surgery and one being a hysterectomy. For all we know, there were complications with the gall bladder surgery, special equipment used, etc. We also don't know what type of gall bladder surgery was performed. Was it laproscopic? Was it a removal? There are any number of factors involved here. The gallbladder surgery bill could've included pre and post-op care. In addition, a gall bladder surgery and a hysterectomy aren't "similar operations".

Both were routine, no complications at all. The gallbladder was laproscopic done in about 50 min, and 1 night was spent in the hospital. The hysterectomy was full surgery taking about 90 min and the hospital stay was 3 days. All indications are that the hysterectomy was more involved yet the surgeon's charge was 20% of the gall bladder operation. Sorry but I am not going to post the bills (one I don't have).

Instead of trying to weave a scenario where I have no grounds to question, why not just say, that does not sound right? Both you and Nova are so intent on making points and winning battles, and Nova pulls "why don't we cut your pay 50% out of his ass" as a means of furthering the discussion. I'm really impressed with his debate skills. :smiley24:

 

[nova]

Instead of trying to weave a scenario where I have no grounds to question, why not just say, that does not sound right? Both you and Nova are so intent on making points and winning battles, and Nova pulls "why don't we cut your pay 50% out of his ass" as a means of furthering the discussion.

And how exactly does your assessment of "that does not sound right" contribute to the conversation?

All you've done is establish that two different surgeons charged two different amounts for two different surgeries, with the only commonality being that some guy performed surgery on someon. Really, no lie. Maybe next you can astonish us with your insightful observation that Wal-Mart and Best Buy charge two different amounts for two different size TVs, or that GM and Ford charge two different prices for two different types of cars.

On top of that, you've use that absolutely ridiculous comparison to strongly imply (that does not sound right after all) that one of those surgeons was nothing but a greedy SOB and thus their charges should be curtailed. If you're going to imply that for others, then I'm just going to come right out and say it for you.

If you don't get my point, then there's no purpose in having this discussion anymore. Ultimately I think you do get my point and don't wanna admit that you don't like the idea of someone else arbitrarily deciding you're a greedy SOB that makes too much but are just fine doing it to others.

I'm really impressed with his debate skills. :smiley24:

Considering the majority of your arguments boil down to "liberals = good, everyone else = evil" I'll take that as a compliment...

 

[retro]

Well, laparoscopic surgeries, while less invasive and faster, take a higher level of expertise, specific training, and highly specialized equipment. What do those factors result in? That's right, a higher cost.

Now, to take this a little bit further, here's a PDF with a breakdown of charges for a laparoscopic cholecystectomy (gallbladder removal) in 2004 in the state of Tennessee, I'm guessing the surgery was a removal, since you said they were "similar".

http://health.state.tn.us/statistics/PdfFiles/HDDS_DRG263.pdf

Wow, it looks like that $18,000 charge was right in line with what happened in Tennessee in 2004. I don't know when this procedure you're talking about was done, but I doubt the numbers have changed significantly since 2004.

Now, according to the National Women's Health Resource Center, in 2007, the average cost of a hysterectomy was $5,145. Different physicians have different contracted rates for services rendered depending on the insurance company they are dealing with, the potential complications involved in the surgery, etc., etc., etc.

Surgery.com - Cervical Cancer Surgery Introduction and Average Cost

So I'd say that, if we are in fact talking about a cholecystectomy and a hysterectomy here, you really don't have any case that the doctor that performed the cholecystectomy was in any way "greedy". Different types of surgeries have different risks involved, potential for lawsuit if something were to go wrong, complexity, etc. You're basically comparing apples and oranges, while they're both fruits, they're completely different in nearly every other way. You also have to consider the fact that generally, a hysterectomy is performed by an Gynecologist, while a cholecystectomy is performed by a general surgeon.

I'm not trying to debate you into a box here... but it is offensive to hear someone talk about how "greedy" doctors are for what they charge without considering all of the facts.

 

[nova]

Hmm, I think somebody around here at said this several times....

http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers

Abstract
Life expectancy in the United States fares poorly in international comparisons, primarily
because of high mortality rates above age 50. Its low ranking is often blamed on a poor
performance by the health care system rather than on behavioral or social factors. This paper
presents evidence on the relative performance of the US health care system using death
avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well
in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and
strokes, and medication of individuals with high levels of blood pressure or cholesterol. We
consider in greater depth mortality from prostate cancer and breast cancer, diseases for which
effective methods of identification and treatment have been developed and where behavioral
factors do not play a dominant role. We show that the US has had significantly faster declines in
mortality from these two diseases than comparison countries. We conclude that the low longevity​

ranking of the United States is not likely to be a result of a poorly functioning health care system.

 

[Alien Allen]

I think Minor is basing it on about the same amount of time spent to operate. Which does not take in a lot of factors. I bet insurance alone is higher for the lapriscopy and there was additional training. Is it worth triple the cost? I dunno

 

[Minor Axis]

And how exactly does your assessment of "that does not sound right" contribute to the conversation?

I'm dealing with a couple of people in this forum (Allen excluded) who don't bat an eye at an outrageous amount for an operation because they want to win the current forum health care debate. There is no hope for you.

Who here besides the two disciples, thinks that $18k is just fine for a 50 min routine operation? Anyone? How would you like to be the one who is handed that bill?

 

[nova]

I think Minor is basing it on about the same amount of time spent to operate. Which does not take in a lot of factors.

I think minor is avoiding the crux of the discussion because he knows his core position of "Those bastards are charging too much" is fundamentally indefensible.

I guess minor thinks that a brand new Corvette should cost as much as a busted up Pinto because they're both cars too...

I'm dealing with a couple of people in this forum (Allen excluded) who don't bat an eye at an outrageous amount for an operation because they want to win the current forum health care debate. There is no hope for you.

No you're dealing with a couple people who aren't going say whatever you want without backing it up. I know in liberal land all you have to do is say "I think" and it may as well be fact handed down by god himself but in the real world we require a bit more evidence.

What exactly is your basis for calling those fees outrageous? What information are you basing that on other than the fact that two different surgeries by two different surgeons cost two different amounts? Answer those two direct questions don't just repeat yourself for the 10th time that they're "outrageous."

If you can't do that, then there's no hope for you because it shows you really don't care to have real discussion about anything.

BTW, if you think the fees are that outrageous, go to the fucking witch doctor instead of the MD next time. I hear its a lot cheaper, the results just aren't as consistent...

 

[Accountable]

If this is so easy, why hasn't it been accomplished months ago? Never mind, I know your answer "Dems are idiots". Secondly I'm curious, do you think the Republican Party if they were the majority would accept your proposal?

Still trying to cram me into your little convenient cubbyhole, eh? You're short-term memory's as bad as mine, otherwise you'd remember the numerous times I've lumped the repubs and your precious dems into the same shit pile.

Nothing resembling Nova's suggestion will ever come out of the chambers of today's congress because it fails the number one test: it doesn't increase federal government control. Indeed it reduces it. Okay, you can uncover your eyes now, I'm done.

 

[Alien Allen]

I'm dealing with a couple of people in this forum (Allen excluded) who don't bat an eye at an outrageous amount for an operation because they want to win the current forum health care debate. There is no hope for you.

Who here besides the two disciples, thinks that $18k is just fine for a 50 min routine operation? Anyone? How would you like to be the one who is handed that bill?

I still would like to see the full details Minor.

Insurance is an overhead. Getting more training to be approved for the procedure is an overhead.

If you want a better example of absurd cost consider this one. About 6 years ago my 20 year old son badly cut his finger. Should have gone to a clinic but the first reaction was to go to the hospital. He ended up with 5 stitches. The bill was $1300

That is a crazy charge for what a doctor could do. In fact as a kid my pediatrician stitched me up. The silly part is that my son was an EMT at the time and could have stitched himself if he had the stuff to do it.

Health care has so many bureaucratic problems that it is mind boggling. Another example is I have to get a phlebotomy every 3 months which is draining blood. My wife is a registered phlebotomist and could do this but the laws do not allow it. So I have to go to a specialist to get it done. My primary care doc said she did not think they were allowed to do it and i had to go to a specialist. And Blue Cross deems it as diagnostic rather than maintainance so the charges are higher and I have to pay part of it where if the primary did it I would not.

 

[Minor Axis]

Still trying to cram me into your little convenient cubbyhole, eh? You're short-term memory's as bad as mine, otherwise you'd remember the numerous times I've lumped the repubs and your precious dems into the same shit pile.

Nothing resembling Nova's suggestion will ever come out of the chambers of today's congress because it fails the number one test: it doesn't increase federal government control. Indeed it reduces it. Okay, you can uncover your eyes now, I'm done.

Sorry, I'm not intentionally lumping you. I just mention the Republicans because at this moment in time, they are the other party.

If you want a better example of absurd cost consider this one. About 6 years ago my 20 year old son badly cut his finger. Should have gone to a clinic but the first reaction was to go to the hospital. He ended up with 5 stitches. The bill was $1300

Without knowing any details other than the operation/price I can say "outrageous"! I'd be happy just being paid a measly $300 per hour for my services much less than $18K plus.

 

[retro]

Without knowing any details other than the operation/price I can say "outrageous"! I'd be happy just being paid a measly $300 per hour for my services much less than $18K plus.

But you don't know the details of the surgery. You can call it a routine surgery, but it's still specialized, and something that a surgeon needs to undergo specific training for. A surgeon spends 5-6 years in surgical residency after medical school. Laparoscopic surgeries, while becoming the norm for a lot of types, are still considered to be fairly new technology, and require a great deal of precision, training, and expensive equipment. You still haven't provided a breakdown of what that bill was. Something tells me that it didn't just say "Gallbladder Surgery - $18,000". There has to be a breakdown with the CPT and possibly ICD-9 codes indicating exactly what was performed. In addition, despite the fact that the surgeon submitted a bill for $18,000, chances are that he was reimbursed a much lower percentage of that number.

There are so many factors that go into practicing medicine that you obviously have absolutely zero clue about. Yet you're here spouting off how surgeon X "overcharged" for surgery Y. You've obviously spent no time in the medical field, either as a provider or ancillary staff. You have no basis for your claims of greed or overcharging other than your own personal assessment that this procedure was overcharged for... even when confronted with factual evidence that the charge was well within the norm. In addition, the evidence of your complete lack of knowledge in this field was further bolstered by the fact that you tried to compare a hysterectomy to a cholecystectomy. Two completely different surgeries, undertaken in two completely different fashions, generally by two completely different type of physicians.

You're calling me a "disciple" of how health care is run now.... that further proves that you haven't paid attention to a damn thing that I've said. I've been preaching health care reform... reform, not government run health care. We need tort reform, medicare/medicaid reform, and pharmaceutical reform. The only "disciple" I see around here is you, worshiping at the altar of UHC.

 

[nova]

Without knowing any details other than the operation/price I can say "outrageous"! I'd be happy just being paid a measly $300 per hour for my services much less than $18K plus.

You can continue to say it and you can continue to be wrong. The longer you keep going with that farce logic the more ridiculous it sounds.

A 50" flat screen TV should cost as much as a 19" tube since they're both TVs right?

A Ferrari F430 should cost as much as a Ford Taurus since they're both cars right?

A one bedroom shack should cost as much as a 50 room mansion since they're both houses right?

And as far as being happy with $300/hour vs $18k/hour, haul your ass to med school and do the surgical residency and then we'll see if

A. That satisfaction with $300/hour continues and

B. if it does you can go provide that service at what you think is a reasonable rate. Maybe you can provide some competition and drive the cost down.

As it stands, given the info retro posted, it appears that $18k/hour is the going rate and if someone was able/willing to do it cheaper, they would be....

 

[Minor Axis]

And as far as being happy with $300/hour vs $18k/hour, haul your ass to med school and do the surgical residency

Your comparisons are meaningless and based on this post your reasoning skills are faulty. Am I surprised? Nope. Btw, my education/vocation (pilot) cost $1,000,000 of tax payers' money by way of the U.S. military and continues to cost my employer about $20k+ per year for training.

$300 per hour pay, (which I don't make) would be just fine.

 

[nova]

Your comparisons are meaningless and based on this post your reasoning skills are faulty.

Am I surprised? Nope.

Put up or shut up. If my reasoning is faulty how about you use your brilliant reasoning skills to explain how instead of just continually saying "you're wrong, no you're wrong, no really you're wrong."

But you're probably not going to do that. You're probably just going to ignore whatever you can't answer....

Btw, my education/vocation (pilot) cost $1,000,000 of tax payers' money by way of the U.S. military and continues to cost my employer about $20k+ per year for training.

$300 per hour pay, (which I don't make) would be just fine.

What in the name of living FUCK does that have to do with anything? Please tell me what logical path you're using where that is meaningful in any way shape or form. I feel like I'm talking to ralph from the simpsons

Me/retro/etc: It takes a lot of time, money and effort to become a surgeon and there aren't very many of them so they expect to be well compensated for their services.

Minor Axis: My cats breath smells like cat food... :crazy:

Do you somehow think that the fact you spent a year or two in flight school at someone else's expense compares to a surgeon giving up a decade of their life on their own dime? Is your logical reasoning ability REALLY that screwed up?

All you're fucking doing is stating an opinion, and a stupid asinine opinion at that, as a wrote fact.

Its also absolutely mind boggling that you either continue to miss just about every point thrown your way or you're being purposefully obtuse....

 

[Alien Allen]

Your comparisons are meaningless and based on this post your reasoning skills are faulty. Am I surprised? Nope. Btw, my education/vocation (pilot) cost $1,000,000 of tax payers' money by way of the U.S. military and continues to cost my employer about $20k+ per year for training.

$300 per hour pay, (which I don't make) would be just fine.

My flight instructor told me his worst students were those that flew in the military :24::24:

I kid ya not

Tis true

 

[Pabst]

i had a stent put in. total cost? $57,848.58

since my life has improved greatly i'd say it was worth it since life is priceless to me.