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A salt assault
August 27, 2013 4:43 AM   Subscribe

How to Charge $546 for Six Liters of Saltwater - a brief story of the humble bag of saline solution given intravenously at ERs and hospitals, and how one unit of it can be marked up from 86 cents to $91 when given to patients
posted by Blazecock Pileon (69 comments total) 22 users marked this as a favorite

 
Haven't read it yet, but my guess is... $2 for the saline, $7 for the bag it comes in, $40 for the people who put it in you, and $42 for the liability.
posted by markkraft at 4:56 AM on August 27, 2013 [2 favorites]


My grandfather has been in the hospital for more than 2 weeks now and on saline nearly the entire time. But it's in Canada so we aren't being charged for it.

And I recently read a book about a nurse who would take bags of saline, add a little something fatal, and wait for someone to be given those bags. Insulin for free!

(The $91 is for the saline alone, in that example -- there's a separate cost of only $127 for the administration.)
posted by jeather at 5:02 AM on August 27, 2013


Haven't read it yet, but my guess is... $2 for the saline, $7 for the bag it comes in, $40 for the people who put it in you, and $42 for the liability.

$12 to pay for the machine that goes "ping"
posted by thelonius at 5:03 AM on August 27, 2013 [8 favorites]


$42 for the liability.

Only if 1 bag out of 100 kills someone and you have the stupidest person in the world buying your insurance.
posted by eriko at 5:06 AM on August 27, 2013 [3 favorites]


A $546 bag of saline is nothing.

"Well, we now have official word from the Center for Medicare and Medicaid Services that last year it made more than $70 billion — that’s billion with a B — in improper payments. That comes to more than the entire budgets for the Departments of State and Homeland Security."

This NY Times piece reads a bit like Reagan conservatives mocking the government for spending 600 dollars on a toilet seat, whilst ignoring the incomparable waste of billions of dollars in the rest of their defense budget.
posted by three blind mice at 5:10 AM on August 27, 2013 [4 favorites]


Haven't read it yet, but my guess is... $2 for the saline, $7 for the bag it comes in, $40 for the people who put it in you, and $42 for the liability.

I feel like you have sorely neglected the executive classes here. What is this, communism?

(sent from your happily still just about NHS-based UK)
posted by jaduncan at 5:11 AM on August 27, 2013 [2 favorites]


I know someone who was considering getting an MRI scan here in the UK. They could either wait 3 months for an NHS scan (free at point of delivery) or pay £300 to go private and get it that same week. That's less than the 6 litres of saltwater mentioned in the post, ouch.
posted by knapah at 5:14 AM on August 27, 2013 [2 favorites]


This is medical-grade surgical stainless salt we're talking about here people, not your everyday garden salt.
posted by turbid dahlia at 5:14 AM on August 27, 2013 [7 favorites]


Tip of the iceberg.
posted by rmmcclay at 5:16 AM on August 27, 2013 [3 favorites]


Hospital prices are somewhat indicative of the negotiation strategies used by hospitals to settle on reimbursement from insurance companies. And little else.
posted by klarck at 5:16 AM on August 27, 2013


Those reading this who haven't already (and I suspect, those who read the blue a lot already have), should read Stephen Brill's amazing 2013 piece in Time Magazine on what underlies the prices for medical care.
posted by scblackman at 5:23 AM on August 27, 2013 [2 favorites]


Haven't read it yet, but my guess is... $2 for the saline, $7 for the bag it comes in, $40 for the people who put it in you, and $42 for the liability.

You'd think that, but probably the insertion of the IV port and the doctor's time have already been broken out and billed separately. Or else, the second bag ought to be cheaper than the first, and that doesn't appear to be the case.
posted by cotterpin at 5:26 AM on August 27, 2013


Hospitals should just sell us the bag at cost and then ask us if we'd like "bottle service" like they do at fancy restaurants. That way we can cut out those fat-cat overpaid nurses that are gouging all the customers for things they don't need like "IV therapy," "dosage monitoring," and "medical care."
posted by The 10th Regiment of Foot at 5:29 AM on August 27, 2013 [3 favorites]


Haven't read it yet, but my guess is... $2 for the saline, $7 for the bag it comes in, $40 for the people who put it in you, and $42 for the liability.

If liability is a $42 on a $91 transaction for that hospital you should get up and run out of the hospital into busy freeway traffic. You'll be safer even if you do it with your eyes closed.
posted by srboisvert at 5:30 AM on August 27, 2013 [12 favorites]


Those reading this who haven't already (and I suspect, those who read the blue a lot already have), should read Stephen Brill's amazing 2013 piece in Time Magazine on what underlies the prices for medical care.

Stephen Brill interview with Jon Stewart
posted by pracowity at 5:33 AM on August 27, 2013 [3 favorites]


My wife got the statement for some blood work last week. Retail was about $575. The insurance discount was $520, meaning the insurance company paid about $50 and the lab was happy with that. Given that millions of people are getting that 90% discount I have to assume the lab makes money at that price point. So why they hell would they be charing me $575 if we didn't have insurance? That's not just wrong and unethical, it should be illegal.
posted by COD at 5:33 AM on August 27, 2013 [43 favorites]


Are there about nine pages missing from the article? You know, the part where they actually explain why the price is so high instead of just reciting a page of "No Comment" non-answers poorly interspersed with some equally detail-free food poisoning story.
posted by Skorgu at 5:41 AM on August 27, 2013 [2 favorites]


I just got the bill for my recent childbirth, in which the baby started crowning in triage and my husband practically delivered her because all the nurses were too busy. For 45 minutes of saline? $337. Total bill? Over $10K. For less than an hour spent giving birth in their facility.
posted by snickerdoodle at 5:42 AM on August 27, 2013 [3 favorites]


In our society, figuring out how to sell something that costs 44 cents for $546 is the talent of a successful businessman. No laws are being broken, after all. You're encouraged to identify with the seller, not the buyer. Play your cards right and some day it will be you legally entitled to that level of profits.
posted by Obscure Reference at 5:43 AM on August 27, 2013 [3 favorites]


should have done it in the taxi - you'd just have to tip the guy and maybe pay for the seats to be recovered
posted by thelonius at 5:44 AM on August 27, 2013




Haven't read it yet, but my guess is... $2 for the saline, $7 for the bag it comes in, $40 for the people who put it in you, and $42 for the liability.

Medical malpractice claims are not a big driver of healthcare costs.

That is a right wing talking point and it is bullshit.
posted by Aizkolari at 5:45 AM on August 27, 2013 [41 favorites]


It came up in the last discussion, but I learnt something that blew me away:
Alright, so you've probably heard that the reason people enjoy "free" healthcare in Australia and the UK and Canada, etc., etc., is that they pay higher taxes. That money then goes into a big pot and is used to pay for peoples' healthcare. But IN FACT, in the United States, we spend more tax money per capita on healthcare than Germany, Australia, the United Kingdom, or Canada. That's right Hank, you pay more in taxes for healthcare than you would if you were British, and in exchange for those taxes, you get... no healthcare.

Transcript for Why Are American Health Care Costs So High?

posted by Static Vagabond at 5:57 AM on August 27, 2013 [14 favorites]


Path to capitalist glory (unlimited coke, whores and yachts):

1) be unfailingly greedy with no ethical standards

2) Identify human need, ie health, education, etc. (formerly called "rights")

3) Produce and market "product" based on identified need and bribe politicians so you can manipulate laws, corner market, obscure common sense and swindle consumers.

4) Win!
posted by nowhere man at 6:00 AM on August 27, 2013 [3 favorites]


That is a right wing talking point and it is bullshit.

From your first link Alkolari:

“The notion that frivolous claims are routinely resulting in $100 million payouts is not true,” says study leader Marty Makary, M.D., M.P.H., an associate professor of surgery and health policy at the Johns Hopkins University School of Medicine. “The real problem is that far too many tests and procedures are being performed in the name of defensive medicine, as physicians fear they could be sued if they don’t order them. That costs upwards of $60 billion a year. It is not the payouts that are bankrupting the system — it’s the fear of them." (emphasis added.)

The idea that tort reform would not make a significant contribution to a reduction of U.S. health care costs is a bullshit talking point of party which receives campaign donations from the trial lawyers.
posted by three blind mice at 6:01 AM on August 27, 2013 [3 favorites]


$40 for the people who put it in you,

No, the article mentioned that that was billed separately.
posted by MartinWisse at 6:02 AM on August 27, 2013 [8 favorites]


At the risk of stating the obvious, this is the forked tongue of hardcore market-is-best capitalists.

These self same people who declare in one breath that markets drive down prices and increase efficiency embrace strategies and lobby for laws that inhibit the price transparency and market competition that would actually drive down prices and increase efficiency.
posted by MuffinMan at 6:03 AM on August 27, 2013 [7 favorites]


And I recently read a book about a nurse who would take bags of saline, add a little something fatal, and wait for someone to be given those bags. Insulin for free!

I don't get this comment. Is this just a thing from a fiction book or somehow related to the article? Maybe I haven't had enough coffee yet to get it.

Also, yeah, this article seems rather light, except that it's kind of telling there aren't 6 more pages. He can't get the information because it's not available. Guess there's no FOIA for hospitals and their billing stuff. The variety of charges to the different people is just insane.

If any other business charged such varying prices, there'd be far more outrage. But we need medical care, don't have a choice when we're unconscious and possibly dying to negotiate or deny things.
posted by sio42 at 6:06 AM on August 27, 2013


...$2 for the saline,
$7 for the bag it comes in,
$40 for the people who put it in you,
and $42 for the liability.


Reaping billions in profit while killing off the uninsured poor... priceless.
posted by ceribus peribus at 6:11 AM on August 27, 2013 [1 favorite]


It's such an American tale.
posted by ZeusHumms at 6:15 AM on August 27, 2013


3bm, here's an article from Forbes putting medical malpractice costs at 2.4% of the total cost of healthcare in the US. This MD agrees that malpractice costs are not a big contributor to costs.

I can't do better research on this right now, sadly, but my understanding is that the difference in healthcare costs between states that have enacted tort reform and those that have not is very small.
posted by Aizkolari at 6:16 AM on August 27, 2013 [3 favorites]


It is not the payouts that are bankrupting the system — it’s the fear of them." (emphasis added.)

The idea that tort reform would not make a significant contribution to a reduction of U.S. health care costs is a bullshit talking point of party which receives campaign donations from the trial lawyers.


LOL. Fear of an insured risk is driving doctors to make money off excess tests! I really didn't want to buy a new merc every two years but I just so scared.
posted by srboisvert at 6:21 AM on August 27, 2013 [6 favorites]


No, the article mentioned that that was billed separately.

Hey, thanks for reading the link!
posted by Blazecock Pileon at 6:28 AM on August 27, 2013 [5 favorites]


"Well, we now have official word from the Center for Medicare and Medicaid Services that last year it made more than $70 billion — that’s billion with a B — in improper payments. That comes to more than the entire budgets for the Departments of State and Homeland Security."

Oh, brilliant, this argument again. Well guess what: in that same time from your link, the private health care was way worse in fraud, waste, and abuse. You see, your figures translate to a rough error rate of about 9%, in relation to the total budget. Yet during the same time period the improper payment rate for private insurers was more than double that, at 20%.

And that doesn't even get us started on how government-funded health care systems are pretty damn good at efficacy. In almost every single objective comparison, they have shown to be more efficient and effective than most or all of the private alternatives, often by wide margins. Medicare, for instance, outperforms most private insurers, often by a good margin (PDF) when it comes to efficiency, despite being many times larger. And it does it consistently from year to year, too (PDF). Meanwhile, Medicaid reliably has better cost constraints compared to private insurers (and, for that matter, Medicare and FEHP) because "no payer has been as motivated to undertake cost containment as state governments."
posted by zombieflanders at 6:29 AM on August 27, 2013 [21 favorites]


The reason we have this is that there is not actually a market for health care in the US.

A market is where consumers line up with producers, both acting as more-or-less rational actors, to purchase goods/services at market clearing prices. Inefficiencies in the market can lead to either goods/services going unconsumed, or to consumers paying prices that are too high/low. The cause of both of those problems is generally a lack of information on one side (or both).

That's not what we have here. We've got a situation where neither the consumer nor the producer has any freaking clue what the prices are. Producers generally aren't aware of their own cost structures. Consumers don't have any idea what producers are actually charging until after the services are provided, and even then they generally don't have any idea how much other producers in the area might be charging. And consumers certainly don't understand why certain goods/services cost what they do, mostly because the producers don't either.

That, my friends, is not a market. It's a disaster is what it is. No one has any idea what's going on, because the information which might theoretically lead to the elimination of inefficiencies doesn't exist. We've got a situation where no one, not consumers, not producers, are acting rationally.

And it's not just because health care is somehow unique and important. It's because the information which might enable patients to make rational choices about their health care consumption simply doesn't exist. It's not that providers are concealing the information--they don't have it either! The people with information about the nature, kind, quality, and quantity of services being provided (i.e., doctors and nurses, mostly) don't know jack about pricing, and the people with information about pricing (i.e., bean counters and bureaucrats) generally haven't the faintest clue about the goods/services they're pricing!

So I say again, what we have here is not a market. It's a farce.

But I think there's a way of fixing that. See, single payer might appear to be a solution, but it's not really a market solution. Patients still don't have any idea about prices, and you get weird inefficiencies like this one, which I'm given to understand are pretty much the norm in such systems. Rather, the way to fix it is to do health insurance more like car insurance.

First: divorce health insurance from employment. There's no bloody reason for the connection. Why do we want employers having information about our health anyway? It's dead weight overhead for employers and an invasion of privacy for employees. So get rid of it. This would have to be done on the federal level, and it could be done one of two ways. Either eliminate the tax deduction for health insurance, or make all health insurance tax deductible. You'd also have to eliminate the employer mandate from the ACA, but that's kind of the point.

Second: ban the practice of charging different patients different effective prices. It's already the case that the gross charge has to be the same for everyone, but hospitals get around that by negotiating discounts with insurers, including Medicare (though that's not much of a negotiation, now is it?). Make it illegal to offer discounts except for charity cases and debt collection settlements. This would probably need to be done on the state level.

Third: require health care providers to give an itemized estimate of the total cost of each good/service before it is delivered. None of this get-treated-now-get-the-bill-later-holy-shit-you-bastards nonsense. Again, state level.

Fourth: require health care providers to allow patients to object to items on the estimate. Maybe the hospital wants to do six MRIs. Maybe three would be okay. The patient, either on his own or armed with a second opinion, can say "Okay, that's excessive. Let's tone it down." Etc. Require health care providers to disclose the availability of cheaper options. Again, state level.

I think that'd mostly fix it. It's a total pipe dream and will never happen, but it'd fix most of the main problems with health care as it currently exists in the US, I should think. There's reason to believe that patients aren't completely irrational about treatment plans when they're given adequate information. And if they know how much something is going to cost, you can bet they're going to try to economize.

And there's tons of economization to be done. Designer drugs? Orders of magnitude more expensive than the generics they're intended to replace, but in the vast majority of cases they're only marginally better. If it's a choice between $10 a month and $200 a month out-of-pocket, and patients are told about it ahead of time, they'll do the math. Etc.

Okay, I gotta do some actual work now. But this stuff just pisses me off.
posted by valkyryn at 6:39 AM on August 27, 2013 [13 favorites]


weird inefficiencies like this one

I would love to live in a weird, inefficient society where I'd pay ~$500 for an MRI that I could also get for free, if I wait. Probably because an MRI costs more than $500, even with the coverage I already have. If the NHS/private hybrid is inefficient, then let's have that kind of inefficiency, because it is a lot cheaper than the free market solution the US has.
posted by Blazecock Pileon at 6:47 AM on August 27, 2013 [16 favorites]


No-brainer money-saving tip: Keep a ziploc bag of salt water in your fridge for hospital visits.
posted by orme at 6:50 AM on August 27, 2013 [1 favorite]


See, single payer might appear to be a solution, but it's not really a market solution. Patients still don't have any idea about prices, and you get weird inefficiencies like this one, which I'm given to understand are pretty much the norm in such systems.

No, it's the norm in pretty much all health systems due to an artificial scarcity of doctors, which leads to vast wage inflation which eats into the budget for medical equipment.

Real market inefficiencies would be swallowed by the sheer economics of scale of a single-payer system. Healthcare is hard work to understand, and not everyone has the time, inclination or ability to go over their medical options line by line. Sensible guidelines set down by industry experts - with the ability to chose alternate options as the situation requires - combined with real insight into pricing and efficacy would be vastly cheaper than insurance-model healthcare.
posted by Slap*Happy at 6:52 AM on August 27, 2013 [2 favorites]


Patients still don't have any idea about prices, and you get weird inefficiencies like this one, which I'm given to understand are pretty much the norm in such systems.

That's neither weird nor inefficient.
posted by jsturgill at 6:52 AM on August 27, 2013 [4 favorites]


But I think there's a way of fixing that. See, single payer might appear to be a solution, but it's not really a market solution. Patients still don't have any idea about prices, and you get weird inefficiencies like this one, which I'm given to understand are pretty much the norm in such systems.

Is that really a weird inefficiency? The people who know what both the actual cost and medical utility of this MRI are (if you're 'considering it' then you're probably not leaking CS fluid) have examined the patient and based on the perceived medical utility are able to fit it in a few months from now.

The parallel free market, where patients can pay what they think the service is worth and providers can charge what they want also exists. Since the business providing the private sector MRI scans mostly charges people paying with their own money (and the occasional private insurance patient) they have a very good idea of the price at which they will be able to sell all their capacity.
posted by atrazine at 6:56 AM on August 27, 2013 [1 favorite]


The NHS existing keeps private healthcare costs down here. If it was just private healthcare, I can basically guarantee that the cost of a private MRI scan would skyrocket.
posted by knapah at 6:58 AM on August 27, 2013 [3 favorites]


My wife spent 7 days in hospital after the birth of our last daughter. Cost us 1000 USD because we went to a private hospital with restaurant quality food. I felt ripped off because I didn't think a private room and some better food were worth the price. Guess it was only 2 bags of water that made the difference ;)
posted by sebas at 6:59 AM on August 27, 2013


Efficient markets require that both sides of the transaction know what they hell they are doing. As healthcare consumers, we often don't, and don't have time to figure it out. If you are in the ER bleeding you are not going to walk out so you have time for a second opinion. If you go car shopping and absolutely have to have a car tomorrow, you will almost certainly pay more than you need to. When purchasing healthcare, we are often, if not usually, in that need it right now mode. Market based economics is never going to work in that market. It has to be regulated.

Dental care, corrective laser eye surgery, cosmetic plastic surgery are all heath care markets where the markets are more free and efficient, primarily because the work is usually not so time sensitive. Consumers can and do decide to do without.

They are also markets where insurance is less pervasive. I doubt that is a coincidence.
posted by COD at 6:59 AM on August 27, 2013 [1 favorite]


artificial scarcity of doctors

What artificial scarcity?
posted by valkyryn at 6:59 AM on August 27, 2013


Market based economics is never going to work in that market. It has to be regulated.

The two are not mutually exclusive. Auto insurance is a highly regulated market that nonetheless functions as a market. Health care does not.
posted by valkyryn at 7:00 AM on August 27, 2013 [4 favorites]


We've got a situation where neither the consumer nor the producer has any freaking clue what the prices are

That's why Obamacare requires hospitals to start disclosing prices. For the first time the public has all this great data about what medical procedures cost. And can compare, and investigate. That data release is why you're seeing articles like this one, or the NYTimes' coverage, or Washington Post.
posted by Nelson at 7:06 AM on August 27, 2013 [13 favorites]


In Ontario, the price premium on private MRIs runs between $500 and $1500, trending to the low end. Prices have dropped from many thousands when they first started. There's apparently been an incentive for the private clinics to drop prices over time, presumably with technology improvements, competition between each other and as the governments have worked to reduce wait times for access.

The provincial target for an MRI is now 28 days, with real wait times around 60 days. That's down from about 120 days, a decade or so ago. There's a way to see this as a private service backfilling a public service that has taken a decade or more to meet demand. Pay more to jump the queue (whether that's a good thing is another discussion). However, as the queue has gotten shorter, demand and price has fallen.
posted by bonehead at 7:11 AM on August 27, 2013 [1 favorite]


Auto insurance is a highly regulated market that nonetheless functions as a market. Health care does not.

I don't think health insurance and auto insurance are really analogous though. Obamacare is an effort to fix healthcare by piling more regulation onto health insurance. However, health insurance is not insurance as much as it is pre-paid health care. I don't file a claim when I get my oil changed or replace my brake pads on a car. Yet we do expect our health insurance to pay for all that routine maintenance of ourselves.

I'm with you on getting the employers out of it. I'm old enough to remember when there was no exclusion for continuous insurance on pre-existing conditions and people with any sort of expensive condition could not change jobs without giving up health insurance for 18 months.

Another thought - auto mechanics generate a tons of questions on Ask Mefi. Why? Because the same sort of information disparity exists between you and the mechanic as does between you and the doctor. Often, you have no choice but to trust them. As least with the car you can often wait, get a 2nd opinion, do research, etc. We all can probably do more of that with doctor too, but that is easy to say when I'm not the one sitting in the examination room facing down a possible ugly diagnosis.
posted by COD at 7:11 AM on August 27, 2013 [3 favorites]


As least with the car you can often wait, get a 2nd opinion, do research, etc.

When my car blows out a ball joint, I can get a new car if repairs cost too much.

When my hip blew out it's joint, I could get an expensive surgery, or never walk again.

All rationality disappears when it's purely self interest on the line.
posted by Pogo_Fuzzybutt at 7:20 AM on August 27, 2013 [4 favorites]


I read the article but could discern no clear answer to the question posed in its headline.
posted by swift at 7:21 AM on August 27, 2013 [1 favorite]


artificial scarcity of doctors

What artificial scarcity?


If you really have no idea what people are alluding to with this, you have no businesses opining on the state of medical care in the US.
posted by Steely-eyed Missile Man at 7:23 AM on August 27, 2013 [11 favorites]


I hate the car insurance analogy for health insurance because for cars there is only "routine maintenance" and "catastrophe"; there is no equivalent of chronic illness. If your car were "chronically ill", you would sell it or junk it and buy a new car. Those of us with chronic illness don't really have that option. Yes, our "designer drugs" are expensive--no, other drugs don't work for many conditions because "designer drugs" are sometimes actually better than generic drugs. Yes, we have to see expensive specialists and will for the rest of our lives. Yes, this makes everyone's insurance cost more. The alternative is that our chronic conditions go untreated until we are too disabled to work, then we go on federal disability. That is not a cheaper or more optimal solution.
posted by hydropsyche at 7:24 AM on August 27, 2013 [6 favorites]


My wife spent 7 days in hospital after the birth of our last daughter. Cost us 1000 USD...

That sounds astonishingly reasonable compared to what I've payed (average $5k) with three births that never involved more than 2 days of hospital time and no birth complications.
posted by dgran at 7:35 AM on August 27, 2013


That sounds astonishingly reasonable compared to what I've payed

That's because you are in Charlottesville and sebas is in Switzerland. Frankly I'm surprised you managed to pay so little, given your location.
posted by Steely-eyed Missile Man at 7:40 AM on August 27, 2013 [1 favorite]


What artificial scarcity?

Artificial scarcity was imposed by the AMA and others through controls on medical school enrollment, regulating the supply of doctors and thus pricing:

For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.
posted by Blazecock Pileon at 7:51 AM on August 27, 2013 [3 favorites]


Blame the American Medical Association. Because more doctors in the labor market would drive down doctor's salaries.
Doctors–and many Republicans–constantly carp about the costs of “defensive medicine” because it forces providers to perform unnecessary procedures and tests to insulate them from potential lawsuits. But excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does....

But how has the AMA managed to get away with such princely remuneration that ordinary mortals in other professions–even ones such as law and engineering that also require arduous training–can only dream of? After all, in a functioning market, a profession offering such handsome returns would become a magnet for more people who, over time, would bid down “excess” wages.

But that’s not how it has worked in medicine since 1910 when the Flexner report, commissioned by the AMA, declared that a surplus of substandard medical schools in the country were producing a surplus of substandard doctors. The AMA convinced lawmakers to shut down “deficient” medical schools, drastically paring back the supply of doctors almost 30% over 30 years. No new medical schools have been allowed to open since the 1980s.

Still, the AMA along with other industry organizations until recently had issued dire warnings of an impending physician “glut” (whatever that means beyond depressing member wages), even convincing Congress to limit the number of residencies it funds to about 100,000 a year. This imposes a de facto cap on new doctors every year given that without completing their residencies from accredited medical schools, physicians cannot obtain a license to legally practice medicine in the U.S. Even foreign doctors with years of experience in their home countries have to redo their residencies–along with taking a slew of exams–before they are allowed to practice here.
The Evil-Mongering of the AMA
posted by Pirate-Bartender-Zombie-Monkey at 7:55 AM on August 27, 2013 [3 favorites]


three blind mice: "The idea that tort reform would not make a significant contribution to a reduction of U.S. health care costs is a bullshit talking point of party which receives campaign donations from the trial lawyers."

The poor, poor doctors, being held hostage by the trial lawyers. It's fucking crazy out there, donchaknow?
posted by wierdo at 8:10 AM on August 27, 2013


artificial scarcity of doctors

What artificial scarcity?


Seriously?
posted by jsturgill at 8:11 AM on August 27, 2013 [2 favorites]


The idea that tort reform would not make a significant contribution to a reduction of U.S. health care costs is a bullshit talking point of party which receives campaign donations from the trial lawyers.

It has been empirically proven that tort reform does not reduce health care costs. Myungho Paik et al., Will Tort Reform Bend the Cost Curve? Evidence from Texas, 9 J. Emp. L. Stud. 173 (2012). The link is to the full paper (free) on SSRN. Here's the abstract:
Will tort reform “bend the cost curve?” Health-care providers and tort reform advocates insist the answer is “yes.” They claim that defensive medicine is responsible for hundreds of billions of dollars in health-care spending every year. If providers and reform advocates are right, once damages are capped and lawsuits are otherwise restricted, defensive medicine, and thus overall health-care spending, will fall substantially. We study how Medicare spending changed after Texas adopted comprehensive tort reform in 2003, including a strict damages cap. We compare Medicare spending in Texas counties with high claim rates (high risk) to spending in Texas counties with low claim rates (low risk), since tort reform should have a greater impact on physician incentives in high-risk counties. Pre-reform, Medicare spending levels and trends were similar in high- and low-risk counties. Post-reform, we find no evidence that spending levels or trends in high-risk counties declined relative to low-risk counties and some evidence of increased physician spending in high-risk counties. We also compare spending trends in Texas to national trends, and find no evidence of reduced spending in Texas post-reform, and some evidence that physician spending rose in Texas relative to control states. In sum, we find no evidence that Texas’s tort reforms bent the cost curve downward.
(emphasis added). Tort reform doesn't work to reduce costs. There may be other reasons to do it, but cost-saving is not one of them. At best any efficiency gains just get absorbed by the insurers as higher profits.
posted by jedicus at 8:13 AM on August 27, 2013 [15 favorites]




orme: "No-brainer money-saving tip: Keep a ziploc bag of salt water in your fridge for hospital visits."

Actually, that leads to a good money-saver medical supply tip.

Take two ziploc bags. Fill one with 50% water/50% rubbing alcohol. Seal and place inside second bag. Seal second bag and throw in freezer. That gives you a flexible ice pack that is cheap and will fit just about anywhere, conforming to any geometry.

(I know this as I have knee problems, and that is putting it kindly.)
posted by Samizdata at 8:22 AM on August 27, 2013 [8 favorites]


The idea that tort reform would not make a significant contribution to a reduction of U.S. health care costs is a bullshit talking point

Why do people cling to this nonsense idea when it has been so thoroughly debunked by actual, real-world experiments in those states which have, in fact, enacted tort reform. It's almost impossible to get a lawyer in California to take a malpractice case nowadays because the payout caps is so low.
posted by yoink at 9:31 AM on August 27, 2013 [7 favorites]


Patients still don't have any idea about prices, and you get weird inefficiencies like this one, which I'm given to understand are pretty much the norm in such systems.

Having lived with both NHS and OHIP (Ontario, Canada) systems I can tell you that I never knew how much things cost. I also never worried about it. It was wonderful.

In the U.S. I supposedly have good health care which I can't quite figure out, covering something but not everything, that will run out if I ever really need it, and requires me to be an expert in medical billing and consuming and this costs me and my wife about a 1/12th our gross income per year plus all the time and worry.

I'd actually pay more to have what I used to get for much less. Which I suspect is what American health care reform will eventually deliver. And it will still be a fucking relief.
posted by srboisvert at 9:36 AM on August 27, 2013


It's got electrolytes.
posted by hal9k at 9:55 AM on August 27, 2013 [2 favorites]


It's almost impossible to get a lawyer in California to take a malpractice case nowadays because the payout caps is so low.

Thus making California a refuge for incompetent doctors?

It cuts both ways, you know.
posted by pjern at 10:37 AM on August 27, 2013


Thus making California a refuge for incompetent doctors?

It cuts both ways, you know.


[citation needed]
posted by zombieflanders at 10:51 AM on August 27, 2013


Thus making California a refuge for incompetent doctors?

It cuts both ways, you know.


I have no idea what point you're making. If you're arguing that malpractice caps are a bad idea that can have bad consequences I agree. On the other hand, if the rationale for tort reform is that even good doctors get hit with huge insurance premiums then tort-reform states would be equally attractive to both the competent and the incompetent doctors.

But so far as I can see the effect of tort-reform is mostly that it takes away one avenue of redress from a small number of people whose lives are seriously impacted by medical malpractice. It doesn't seem to make much difference otherwise; it certainly makes no appreciable overall difference in medical costs.
posted by yoink at 11:15 AM on August 27, 2013 [4 favorites]


hal9k: "It's got electrolytes."

It's what patients CRAVE!
posted by Samizdata at 2:17 PM on August 27, 2013 [2 favorites]


The best disinfectant is sunlight; I hope to god that the new disclosure rules in Obamacare help, but my hunch is that without eliminating secret contracts, there's no hope of removing the vast, intentional informational mismatch that allows exploitative pricing.
posted by klangklangston at 3:22 PM on August 28, 2013


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