What really drives the cost of care

[HALL85]

A good article that really gets at the costs of healthcare and why the whole debate on Medicare For All and what drives the cost of healthcare is misdirected. A few things to consider:

* While Pharma shares their responsibility, the cost/capita is much lower than other factors and the growth in spending has been controlled overall over the past 15 years.
* Hospital care and services (primarily physician costs) are the biggest chunk and have risen disproportionally over the same period. So while it's sexy to target Pharma and the Insurance Industry, unless you address the rapidly escalating costs in those two areas (as well as others), it doesn't matter if you continue with our current model or a government run insurance program. Remember, insurance just reimburses for how healthcare is paid for. If the costs are rising, then the "how" part is going to rise as well no matter who provides the coverage.
* Ask yourself why politicians don't go after these culprits....the AHA and AMA fly below the radar and it's more risky for a politician to attack them than go after the "evil" insurance and pharma industry.

https://www.axios.com/hospitals-drug-prices-trump-pharma-223585c8-f085-454d-8e17-078177274d24.html

 

[Merge]

Seems to be a lot missing from that article.

Not saying it's wrong, but in an aging population you would expect costs to be increasing higher than what it would be if the age of the population was a constant. Would be interested in seeing what the average price of specific procedures are by year. I don't really agree with the sentence about sticker prices and negotiations with insurance companies though, that line wasn't accurate. If a Hospital charges $1k for a procedures and an insurance company agrees to pay $250 for it, they aren't going to agree to pay a higher rate if the hospital starts charging $2k.

 

[Pirata]

Tort reform is needed. It drives unnecessary and expensive testing.

It also causes extraordinary insurance premiums for providers in high-risk practices such as OB.

 

[HALL85]

Seems to be a lot missing from that article.

Not saying it's wrong, but in an aging population you would expect costs to be increasing higher than what it would be if the age of the population was a constant. Would be interested in seeing what the average price of specific procedures are by year. I don't really agree with the sentence about sticker prices and negotiations with insurance companies though, that line wasn't accurate. If a Hospital charges $1k for a procedures and an insurance company agrees to pay $250 for it, they aren't going to agree to pay a higher rate if the hospital starts charging $2k.

There’s a thing called the Hospital Charge Master which is the basis for negotiating with insurance providers. So, yes, they artificially drive the sticker price up to negotiate from there. Capital investment by hospital systems is at an all time high....where is that cash or ability to borrow coming from? The article is not meant to be an end all but it’s directionally correct

 

[Merge]

Yeah I used to audit a few hospitals. In my limited experience (3 years auditing 3 hospitals) it didn’t really matter where they set the rates the insurance companies typically came back saying this is what we pay for x procedure. They wouldn’t agree to pay more just because a hospital decides to charge more.

Just saying there is a good amount of data missing from that article especially from a background where I used to write up narratives explaining revenues and what was driving any changes year to year and I included a lot more in my analytics such as demographics and a comparison of the services provided each year etc.

 

[HALL85]

Yeah I used to audit a few hospitals. In my limited experience (3 years auditing 3 hospitals) it didn’t really matter where they set the rates the insurance companies typically came back saying this is what we pay for x procedure. They wouldn’t agree to pay more just because a hospital decides to charge more.

Just saying there is a good amount of data missing from that article especially from a background where I used to write up narratives explaining revenues and what was driving any changes year to year and I included a lot more in my analytics such as demographics and a comparison of the services provided each year etc.

Then you would know rate setting is a negotiation and the HCM is used as a tool to indicate what the hospitals costs are.

I’ve already agreed that it’s a summary article that is directionally correct.

 

[SHUHoopsFan]

It goes deeper than that. Why do people get so sick is the even bigger question? People exceed the recommended sugar intake in one sip of soda.
People eating food with so much preservatives that our bodies aren’t meant to handle all so the product can stay on the shelf as long as possible. We hold Phillip Morris accountable for cigarettes but we do nothing to Coca-Cola, McDonalds, etc. The person who dares to risk their career by calling out those companies will be the candidate who truly is willing to do the right thing for the people of this country. Everyone else is not willing to take on the food lobbyists in this country, probably because that would be career ending move.

 

[NYShoreGuy]

It goes deeper than that. Why do people get so sick is the even bigger question? People exceed the recommended sugar intake in one sip of soda.
People eating food with so much preservatives that our bodies aren’t meant to handle all so the product can stay on the shelf as long as possible. We hold Phillip Morris accountable for cigarettes but we do nothing to Coca-Cola, McDonalds, etc. The person who dares to risk their career by calling out those companies will be the candidate who truly is willing to do the right thing for the people of this country. Everyone else is not willing to take on the food lobbyists in this country, probably because that would be career ending move.

Why do people tend to eat unhealthy fast food, it is inexpensive and fast to get...a majority of this country likely doesn't eat out at fancy restaurants more than once a month because of cost and how money has to go to bigger priorities in a household, you can afford a healthy diet from going to farmers markets and supermarkets...i like to eat and I have been to some of the best restaurants in Miami and Vegas on vacations in the last decade...i am in central jersey/jersey shore area most restaurants are not worth it to be honest...to me when I go out for a great meal I want to eat something that I cant prep/cook myself....i stopped drinking soft drinks at age 23, I don't take in caffeine, I watch salt in take...in Feb of 2018 I got a big wake up call on labs and cut out cold cuts and incorporated super foods into my diet....i also go on outdoor exercise events....a lot of Americans sit in office chairs 40 plus hours a week and then are not active and either drink booze or sugar and like garbage

 

[HALL85]

It goes deeper than that. Why do people get so sick is the even bigger question? People exceed the recommended sugar intake in one sip of soda.
People eating food with so much preservatives that our bodies aren’t meant to handle all so the product can stay on the shelf as long as possible. We hold Phillip Morris accountable for cigarettes but we do nothing to Coca-Cola, McDonalds, etc. The person who dares to risk their career by calling out those companies will be the candidate who truly is willing to do the right thing for the people of this country. Everyone else is not willing to take on the food lobbyists in this country, probably because that would be career ending move.

Yes, that’s the other side of the equation. Much our healthcare costs can be traced back to consumption and lifestyle. Processed foods, portion control combined with more sedentary choices contribute heavily to our per capita cost of healthcare. I saw a study last year that tracked costs in US vs several other industrialized nations. The graphs were identical to age 65 then the US spiked while the other nations tracked closely together. There were a handful of reasons why most notably the dramatic increases Diabetes Type 2 and heart disease. Years of poor choices add up and we think camouflaging it with meds enables us to keep making bad choices.

 

[SHUHoopsFan]

Why do people tend to eat unhealthy fast food, it is inexpensive and fast to get...a majority of this country likely doesn't eat out at fancy restaurants more than once a month because of cost and how money has to go to bigger priorities in a household, you can afford a healthy diet from going to farmers markets and supermarkets...i like to eat and I have been to some of the best restaurants in Miami and Vegas on vacations in the last decade...i am in central jersey/jersey shore area most restaurants are not worth it to be honest...to me when I go out for a great meal I want to eat something that I cant prep/cook myself....i stopped drinking soft drinks at age 23, I don't take in caffeine, I watch salt in take...in Feb of 2018 I got a big wake up call on labs and cut out cold cuts and incorporated super foods into my diet....i also go on outdoor exercise events....a lot of Americans sit in office chairs 40 plus hours a week and then are not active and either drink booze or sugar and like garbage

Eating at fancy restaurants isn’t the answer. Fancy steaks still have excessive amounts of hormones and other things in them. The flour we have in this country is processed terribly whether it’s the bun at McDonalds or pasta at a 5 star Italian restaurant. I have friends with diabetes and Chron’s disease. Both went to Italy ate pizza and pasta and didn’t experience their problems once. The stuff in our food is illegal in a lot of countries.

 

[HALL85]

Eating at fancy restaurants isn’t the answer. Fancy steaks still have excessive amounts of hormones and other things in them. The flour we have in this country is processed terribly whether it’s the bun at McDonalds or pasta at a 5 star Italian restaurant. I have friends with diabetes and Chron’s disease. Both went to Italy ate pizza and pasta and didn’t experience their problems once. The stuff in our food is illegal in a lot of countries.

Bingo....spot on. Plus “expensive” restaurants use excessive amounts of butter, sugar and salt to enhance the flavor.

 

[Pirata]

Eating healthy is not expensive. It does require a little education and a good bit of discipline.

You can eat healthy at virtually any restaurant simply by knowing what to eat and telling the server specifically what you want.

There are may conflicting theories/diets which causes confusion for many people. For the under-educated and those not inclined or capable of researching and making an intelligent decision, it is near impossible to figure out how to eat healthy. You end up eating as your parents did and eating what is easy and tastes good.

Our medical profession has failed at addressing food intake. I cringe when I see the 300 lb person who is on blood pressure and cholesterol medication driving around in their scooter.

"here, take this pill to help lower your cholesterol so you can continue to sit on your ass and stuff Twinkies into your pie hole. Don't worry if you get too fat to walk. Medicare will pay for your scooter."

 

[SHUHoopsFan]

Eating healthy is not expensive. It does require a little education and a good bit of discipline.

You can eat healthy at virtually any restaurant simply by knowing what to eat and telling the server specifically what you want.

There are may conflicting theories/diets which causes confusion for many people. For the under-educated and those not inclined or capable of researching and making an intelligent decision, it is near impossible to figure out how to eat healthy. You end up eating as your parents did and eating what is easy and tastes good.

Our medical profession has failed at addressing food intake. I cringe when I see the 300 lb person who is on blood pressure and cholesterol medication driving around in their scooter.

"here, take this pill to help lower your cholesterol so you can continue to sit on your ass and stuff Twinkies into your pie hole. Don't worry if you get too fat to walk. Medicare will pay for your scooter."

You’re right but the issue is the politicians won’t take on the lobbyist in the food industry that protect sales of sugar, corn syrup etc. There are people that can’t do the research or don’t know how to. The politicians are “the strong” people of society. They have an obligation to protect “the weakest” people. Doing that will destroy companies like coke, Pepsi, General Mills, etc. However letting continue to do business as is makes healthcare a problem.

 

[shu09]

Yes, that’s the other side of the equation. Much our healthcare costs can be traced back to consumption and lifestyle. Processed foods, portion control combined with more sedentary choices contribute heavily to our per capita cost of healthcare. I saw a study last year that tracked costs in US vs several other industrialized nations. The graphs were identical to age 65 then the US spiked while the other nations tracked closely together. There were a handful of reasons why most notably the dramatic increases Diabetes Type 2 and heart disease. Years of poor choices add up and we think camouflaging it with meds enables us to keep making bad choices.

Exactly. This country seemingly has a "pill for everything" when that actually treats the symptoms and not the cause. The bottom line is the majority of people in this country do not live a healthy lifestyle and then they complain as if it's not their fault when they get sick.

 

[HALL85]

You’re right but the issue is the politicians won’t take on the lobbyist in the food industry that protect sales of sugar, corn syrup etc. There are people that can’t do the research or don’t know how to. The politicians are “the strong” people of society. They have an obligation to protect “the weakest” people. Doing that will destroy companies like coke, Pepsi, General Mills, etc. However letting continue to do business as is makes healthcare a problem.

Another example where money drives politics. Until we address campaign finance reform and the flow of money into politics don’t expect anything to happen with the food lobby or any of the other lobbies for that matter.

 

[NYShoreGuy]

Eating at fancy restaurants isn’t the answer. Fancy steaks still have excessive amounts of hormones and other things in them. The flour we have in this country is processed terribly whether it’s the bun at McDonalds or pasta at a 5 star Italian restaurant. I have friends with diabetes and Chron’s disease. Both went to Italy ate pizza and pasta and didn’t experience their problems once. The stuff in our food is illegal in a lot of countries.

This restaurant is now closed but Miami beach had an organic Italian spot that only sat 50 at a time chef went back to Italy...pasta was scratch made with imported semolina from Italy best I ever had

 

[SHUHoopsFan]

This restaurant is now closed but Miami beach had an organic Italian spot that only sat 50 at a time chef went back to Italy...pasta was scratch made with imported semolina from Italy best I ever had

Awesome. If you know of other places like that let me know. Imported is the key word. You don’t get the same quality here. Why? Because our law makers allow companies to use technology in our food. Our bodies were not designed to break down technology.