Drugs for people - cost

[True Grit Farms]

First, insurance companies have an obligation to their share holders to make as much profit as they can. That is capitalism. We should all rejoice in their record profits.

Second, I disagree that individuals cannot fraud large corporations.

First, I never said that large corporations could not be defrauded, they can. This debate has quickly skewed from Health Insurance to Property and Casualty Insurance, which are two entirely different animals. True Grit, Insurance fraud is real and is wrong. This debate was about health insurance.

Ron, the way I read your response, Health Insurers can charge whatever they want in premiums no matter how captive the market and deny to pay for procedures or drugs or treatment, regardless of the reason, all to "rejoice in their profits"? I respectfully disagree that this is the way to provide medical care in a modern civilized society.

I agree with your assessment. The fact is without insurance very few people can afford medical treatment. And if you're self employed you can't afford health health insurance anymore without the AHCA. The problem with health care is that everyone is entitled to it according to the government. Freeloaders, deadbeats, and illegals have no right to free medical care. If you don't pay you don't play.

 

[Bright Raven]

Ron, the way I read your response, Health Insurers can charge whatever they want in premiums no matter how captive the market and deny to pay for procedures or drugs or treatment, regardless of the reason, all to "rejoice in their profits"? I respectfully disagree that this is the way to provide medical care in a modern civilized society.

Yes. We do agree. It is disgusting.

But....the primary tenet of capitalism especially in publicly traded enterprises is to make profits so the share holders get rich. The entire market that we watch every day is about who is and who is not making profit and by how much.

Regarding insurance companies - they are stringently regulated. However, they have one of the most powerful lobbies in Washington.

If we are candid, the only difference between corruption in the US and Zimbabwe is metrics. We are just better at concealing it and in Zimbabwe they don't need to conceal it.

 

[sstterry]

"Freeloaders, deadbeats, and illegals have no right to free medical care."

I don't disagree with you here, but the problem becomes who is the deadbeat and who is the disabled or disadvantaged ? That is the question that this society must struggle with. I do not even pretend to have the answer.

"Regarding insurance companies - they are stringently regulated."

This is where we disagree, Health Insurers are stringently regulated when it comes to Medicare/Medicaid, but not in the other private marketplaces. Also, there is no regulation as to how much Hospital's charge. When was the last time a hospital told you, "hey we are going to put a box of kleenex in your room, but we are going to charge you $50?" Hospitals have contracts with Insurers to only pay a certain amount for each service, but pity the person who doesn't have insurance and has to pay a $40k hospital bill when the person with insurance will only be charged $7k. Those least able to pay get charged the most.

 

[hurleyjd]

Ok, no I am not from Vegas. I was born at Grady Memorial in Atlanta, GA. My husband and adult son just joined the Georgia Cattlemens Association. I remarked that it would be nice to meet some of the Southern gentlemen who have helped us on Cattle Today at the meeting last Thursday.

Again, I paid bi-weekly premiums to Blue Cross for THREE DECADES with a pittance in claims. I mean I would go many years without seeing a doctor until they instituted compliance visits to keep the preferred rate. My husband has the misfortune to need some meds as prescribed by a doctor. I rejoice in legally being able to recoup some of the money I paid in all those years and that equates to stealing?

Your doctor will be taking an all expense vacation from the drug companies that he has prescribed. There are cheaper drugs out there that are just as effective.

 

[Bright Raven]

"Regarding insurance companies - they are stringently regulated."

This is where we disagree, Health Insurers are stringently regulated when it comes to Medicare/Medicaid, but not in the other private marketplaces. Also, there is no regulation as to how much Hospital's charge. When was the last time a hospital told you, "hey we are going to put a box of kleenex in your room, but we are going to charge you $50?" Hospitals have contracts with Insurers to only pay a certain amount for each service, but pity the person who doesn't have insurance and has to pay a $40k hospital bill when the person with insurance will only be charged $7k. Those least able to pay get charged the most.

The right says "let the market work it out and NO REGULATION".

 

[sstterry]

"Regarding insurance companies - they are stringently regulated."

This is where we disagree, Health Insurers are stringently regulated when it comes to Medicare/Medicaid, but not in the other private marketplaces. Also, there is no regulation as to how much Hospital's charge. When was the last time a hospital told you, "hey we are going to put a box of kleenex in your room, but we are going to charge you $50?" Hospitals have contracts with Insurers to only pay a certain amount for each service, but pity the person who doesn't have insurance and has to pay a $40k hospital bill when the person with insurance will only be charged $7k. Those least able to pay get charged the most.

The right says "let the market work it out and NO REGULATION".

That is the problem with today's political climate. This should not be a "right" or "left" issue. But sadly that is what it has become.

 

[TexasBred]

First, insurance companies have an obligation to their share holders to make as much profit as they can. That is capitalism. We should all rejoice in their record profits.

Second, I disagree that individuals cannot fraud large corporations. Especially, insurance companies. In Kentucky there is a huge problem with businesses burning their insured infrastructure when they are underwater. Individuals use the same practice. The last 3 fires in this county were due to arson to collect insurance because the mortgage was more than the value of the home. Happens all the time. I personally knew a man who was a professional at burning property to collect insurance.

Fire caused by friction Ron....a $1,000,000 policy rubbing against a $100,000 mortgage can be very profitable for the property owner.

 

[sstterry]

I personally knew a man who was a professional at burning property to collect insurance.

Do you have his contact information? I am, um, asking for a friend.

 

[sim.-ang.king]

Good for you Vince. Maybe those Georgia Fisherman are the only honest Americans left.

We both know better so I'm not going to touch that one.

Seriously, I may be more socially liberal than you but when it comes to fiscal and economic concepts, I am fiercely conservative. I believe every publicly owned corporation has an obligation to make all the profit possible. I don't consider the pharmaceutical industry as the "evil empire" many do.

It's not exactly capitalism, if the government forces everyone to have health insurance, and provides subsidies to pay medical bills. Any time the government is involved in subsidizing any sector, it's not capitalism.
If people were having to pay their own medical bills without insurance, the prices would be a lot lower.
I can buy any drug through my vet, or from a russian phar., for a tenth of the cost from an american phar. I wonder why???
Could it be that they know they can get the money from a government subsidized insurance plan???
Take the government, and insurance out of picture, and I bet you anything the price of drugs will drop like a rock.
BR I know you were just poking a stick at everyone, hoping someone would yelp. If you truly believed in capitalism, would be able to spot that this government subsidized insurance is not capitalism.

 

[Bright Raven]

I personally knew a man who was a professional at burning property to collect insurance.

Do you have his contact information? I am, um, asking for a friend.

He is dead. Very colorful guy. He would actually take jobs out of state. Fly to a contract destination, burn a building and come back to Kentucky. I was very close to him. One of the most unique individuals, I ever knew in my 67 years.

 

[Bright Raven]

It's not exactly capitalism, if the government forces everyone to have health insurance, and provides subsidies to pay medical bills. Any time the government is involved in subsidizing any sector, it's not capitalism.
If people were having to pay their own medical bills without insurance, the prices would be a lot lower.
I can buy any drug through my vet, or from a russian phar., for a tenth of the cost from an american phar. I wonder why???
Could it be that they know they can get the money from a government subsidized insurance plan???
Take the government, and insurance out of picture, and I bet you anything the price of drugs will drop like a rock.
BR I know you were just poking a stick at everyone, hoping someone would yelp. If you truly believed in capitalism, would be able to spot that this government subsidized insurance is not capitalism.

Capitalism stinks up the whole place. So does representative democracy. I trust that someone is working on better economic/political systems. Until then, they have both been good to me.

 

[NEFarmwife]

So husband was at endocrinologist this morning and he was prescribed a couple more drugs for glucose, thyroid, etc. Jardiance at $400 per month. Keep in mind he is already on Keytruda at $12,500 per month at Emory - $150,000 per year for that one med. He is taking about 14 meds in all. Not complaining as we are blessed to have good insurance but...what happens to people who dont?

You could hock everything you own and still not afford more than about a year. Never invested much in stocks but I cant help but realize drug companies are making a killing. Also, why do we pay so much more in the USA for drugs?

On the brighter side, I did tell the husband that I had once again managed to screw an insurance company legally as the second dose of his keytruda probably covered every payment to Blue Cross/Blue Shield I ever made.

I am just puzzled at how much longer this can go on...

The ONLY reason I work outside our operation is to have affordable, good health care coverage for my family. We are all healthy, thankfully but all my premiums equal what my employer contributes to our deductible...so it is a wash. But my stance on health care reform is, it would actually be reformed if we'd go after the pharmaceutical companies and CAP the price of the product.

 

[Bright Raven]

So husband was at endocrinologist this morning and he was prescribed a couple more drugs for glucose, thyroid, etc. Jardiance at $400 per month. Keep in mind he is already on Keytruda at $12,500 per month at Emory - $150,000 per year for that one med. He is taking about 14 meds in all. Not complaining as we are blessed to have good insurance but...what happens to people who dont?

You could hock everything you own and still not afford more than about a year. Never invested much in stocks but I cant help but realize drug companies are making a killing. Also, why do we pay so much more in the USA for drugs?

On the brighter side, I did tell the husband that I had once again managed to screw an insurance company legally as the second dose of his keytruda probably covered every payment to Blue Cross/Blue Shield I ever made.

I am just puzzled at how much longer this can go on...

The ONLY reason I work outside our operation is to have affordable, good health care coverage for my family. We are all healthy, thankfully but all my premiums equal what my employer contributes to our deductible...so it is a wash. But my stance on health care reform is, it would actually be reformed if we'd go after the pharmaceutical companies and CAP the price of the product.

I don't think the right is going to ever vote for that. It is fundamentally contrary to the platform of the right/conservative to set market caps.

 

[bball]

"Freeloaders, deadbeats, and illegals have no right to free medical care."

I don't disagree with you here, but the problem becomes who is the deadbeat and who is the disabled or disadvantaged ? That is the question that this society must struggle with. I do not even pretend to have the answer.

"Regarding insurance companies - they are stringently regulated."

This is where we disagree, Health Insurers are stringently regulated when it comes to Medicare/Medicaid, but not in the other private marketplaces. Also, there is no regulation as to how much Hospital's charge. When was the last time a hospital told you, "hey we are going to put a box of kleenex in your room, but we are going to charge you $50?" Hospitals have contracts with Insurers to only pay a certain amount for each service, but pity the person who doesn't have insurance and has to pay a $40k hospital bill when the person with insurance will only be charged $7k. Those least able to pay get charged the most.

Something else to consider: hospitals(ERs) are forced to treat whatever walks through the door, regardless of if they have insurance or means to pay the bill. When a significant portion of your clients can not pay the bill, like every other sector in business, guess who it gets passed on to? That's correct, those who can pay. Just like taxpayers that pay the cost for many that can't, won't or don't pay taxes, but still draw the benefits.
I will give you an example. A middle aged man walks into the ER complaining of abdominal pain. He has no insurance and is a self pay customer. His ER work up includes lab draws, abdominal imaging, some IV fluids, perhaps some Zofran for nausea. Imaging reveals he has a perforated bowel and needs emergent surgery. The surgery crew is called in, his surgery is completed and he is admitted inpatient to Med/Surg unit for 3 days post op recovery antibiotics, IV fluids, etc. The ER bills, coupled with his surgery and inpatient bills is substantial as anyone who has been hospitalized well knows. But this gentleman isnt going to pay because he cant. Even if he had Medicare or Medicaid, the reimbursement would barely be a break even for the hospital. If our pt in the scenario complains about any aspect of his visit, reimbursement becomes even less. So who eats this substantial bill? The hospital, ER physicians group and Surgeons group. The same folks that have to pay staff, maintain equipment, building and all the expenses it takes to maintain a facility, not the least of which is insurance of several varieties (fire, malpractice, etc.)

In the above scenario, if the surgery was determined to be non emergent, then the hospital only has to eat the ER work up(still a good chunk of cash) because as an ambulatory or scheduled inpatient procedure, the hospital can collect some payment before the procedure or decline to provide service if payment arrangements can not be made.

I am here to testify, as someone who manages a mid level hospital after normal business hours, this type of scenario occurs very regularly. Small hospitals are closing or consolidating across the nation, mid levels are consolidating or fighting for their existence, even the large operations aren't churning out a tremendous profit in many cases.

These types of occurrences eventually are written off as losses because of inability to collect. No successful business can function for long taking losses.

Just something to consider.

 

[sstterry]

"Freeloaders, deadbeats, and illegals have no right to free medical care."

I don't disagree with you here, but the problem becomes who is the deadbeat and who is the disabled or disadvantaged ? That is the question that this society must struggle with. I do not even pretend to have the answer.

"Regarding insurance companies - they are stringently regulated."

This is where we disagree, Health Insurers are stringently regulated when it comes to Medicare/Medicaid, but not in the other private marketplaces. Also, there is no regulation as to how much Hospital's charge. When was the last time a hospital told you, "hey we are going to put a box of kleenex in your room, but we are going to charge you $50?" Hospitals have contracts with Insurers to only pay a certain amount for each service, but pity the person who doesn't have insurance and has to pay a $40k hospital bill when the person with insurance will only be charged $7k. Those least able to pay get charged the most.

Something else to consider: hospitals(ERs) are forced to treat whatever walks through the door, regardless of if they have insurance or means to pay the bill. When a significant portion of your clients can not pay the bill, like every other sector in business, guess who it gets passed on to? That's correct, those who can pay. Just like taxpayers that pay the cost for many that can't, won't or don't pay taxes, but still draw the benefits.
I will give you an example. A middle aged man walks into the ER complaining of abdominal pain. He has no insurance and is a self pay customer. His ER work up includes lab draws, abdominal imaging, some IV fluids, perhaps some Zofran for nausea. Imaging reveals he has a perforated bowel and needs emergent surgery. The surgery crew is called in, his surgery is completed and he is admitted inpatient to Med/Surg unit for 3 days post op recovery antibiotics, IV fluids, etc. The ER bills, coupled with his surgery and inpatient bills is substantial as anyone who has been hospitalized well knows. But this gentleman isnt going to pay because he cant. Even if he had Medicare or Medicaid, the reimbursement would barely be a break even for the hospital. If our pt in the scenario complains about any aspect of his visit, reimbursement becomes even less. So who eats this substantial bill? The hospital, ER physicians group and Surgeons group. The same folks that have to pay staff, maintain equipment, building and all the expenses it takes to maintain a facility, not the least of which is insurance of several varieties (fire, malpractice, etc.)

In the above scenario, if the surgery was determined to be non emergent, then the hospital only has to eat the ER work up(still a good chunk of cash) because as an ambulatory or scheduled inpatient procedure, the hospital can collect some payment before the procedure or decline to provide service if payment arrangements can not be made.

I am here to testify, as someone who manages a mid level hospital after normal business hours, this type of scenario occurs very regularly. Small hospitals are closing or consolidating across the nation, mid levels are consolidating or fighting for their existence, even the large operations aren't churning out a tremendous profit in many cases.

These types of occurrences eventually are written off as losses because of inability to collect. No successful business can function for long taking losses.

Just something to consider.

This is all true. It is a broken system.

 

[backhoeboogie]

What I don't like are the negotiated rates insurance companies demand. The playing field is no longer level. It causes the medical profession to inflate rates to compensate for their negotiations.

 

[Bright Raven]

Something else to consider: hospitals(ERs) are forced to treat whatever walks through the door, regardless of if they have insurance or means to pay the bill. When a significant portion of your clients can not pay the bill, like every other sector in business, guess who it gets passed on to? That's correct, those who can pay. Just like taxpayers that pay the cost for many that can't, won't or don't pay taxes, but still draw the benefits.
I will give you an example. A middle aged man walks into the ER complaining of abdominal pain. He has no insurance and is a self pay customer. His ER work up includes lab draws, abdominal imaging, some IV fluids, perhaps some Zofran for nausea. Imaging reveals he has a perforated bowel and needs emergent surgery. The surgery crew is called in, his surgery is completed and he is admitted inpatient to Med/Surg unit for 3 days post op recovery antibiotics, IV fluids, etc. The ER bills, coupled with his surgery and inpatient bills is substantial as anyone who has been hospitalized well knows. But this gentleman isnt going to pay because he cant. Even if he had Medicare or Medicaid, the reimbursement would barely be a break even for the hospital. If our pt in the scenario complains about any aspect of his visit, reimbursement becomes even less. So who eats this substantial bill? The hospital, ER physicians group and Surgeons group. The same folks that have to pay staff, maintain equipment, building and all the expenses it takes to maintain a facility, not the least of which is insurance of several varieties (fire, malpractice, etc.)

In the above scenario, if the surgery was determined to be non emergent, then the hospital only has to eat the ER work up(still a good chunk of cash) because as an ambulatory or scheduled inpatient procedure, the hospital can collect some payment before the procedure or decline to provide service if payment arrangements can not be made.

I am here to testify, as someone who manages a mid level hospital after normal business hours, this type of scenario occurs very regularly. Small hospitals are closing or consolidating across the nation, mid levels are consolidating or fighting for their existence, even the large operations aren't churning out a tremendous profit in many cases.

These types of occurrences eventually are written off as losses because of inability to collect. No successful business can function for long taking losses.

Just something to consider.

Thank you for the effort to post that. You may know if this is true - I had a friend in Helena Montana who was a Pediatrician. He claimed doctors do not make as much as public perception. Considering the cost of a practice, malpractice insurance, etc. He like to tell me that I made more than he did.

 

[sstterry]

Something else to consider: hospitals(ERs) are forced to treat whatever walks through the door, regardless of if they have insurance or means to pay the bill. When a significant portion of your clients can not pay the bill, like every other sector in business, guess who it gets passed on to? That's correct, those who can pay. Just like taxpayers that pay the cost for many that can't, won't or don't pay taxes, but still draw the benefits.
I will give you an example. A middle aged man walks into the ER complaining of abdominal pain. He has no insurance and is a self pay customer. His ER work up includes lab draws, abdominal imaging, some IV fluids, perhaps some Zofran for nausea. Imaging reveals he has a perforated bowel and needs emergent surgery. The surgery crew is called in, his surgery is completed and he is admitted inpatient to Med/Surg unit for 3 days post op recovery antibiotics, IV fluids, etc. The ER bills, coupled with his surgery and inpatient bills is substantial as anyone who has been hospitalized well knows. But this gentleman isnt going to pay because he cant. Even if he had Medicare or Medicaid, the reimbursement would barely be a break even for the hospital. If our pt in the scenario complains about any aspect of his visit, reimbursement becomes even less. So who eats this substantial bill? The hospital, ER physicians group and Surgeons group. The same folks that have to pay staff, maintain equipment, building and all the expenses it takes to maintain a facility, not the least of which is insurance of several varieties (fire, malpractice, etc.)

In the above scenario, if the surgery was determined to be non emergent, then the hospital only has to eat the ER work up(still a good chunk of cash) because as an ambulatory or scheduled inpatient procedure, the hospital can collect some payment before the procedure or decline to provide service if payment arrangements can not be made.

I am here to testify, as someone who manages a mid level hospital after normal business hours, this type of scenario occurs very regularly. Small hospitals are closing or consolidating across the nation, mid levels are consolidating or fighting for their existence, even the large operations aren't churning out a tremendous profit in many cases.

These types of occurrences eventually are written off as losses because of inability to collect. No successful business can function for long taking losses.

Just something to consider.

Thank you for the effort to post that. You may know if this is true - I had a friend in Helena Montana who was a Pediatrician. He claimed doctors do not make as much as public perception. Considering the cost of a practice, malpractice insurance, etc. He like to tell me that I made more than he did.

I can tell you that in some instances this is definitely true. A lot depends on the practice type and the patient load. I do not fault the physicans in the current system. Some of them struggle just like the rest of us.

 

[BrangusUSA]

Carroll County, GA GCA chapter

I guess my whole point on the post was: What about the middle class people who dont have health insurance? Perhaps they have health insurance but it is capped or has lifetime limits? Some dont live within range of a clinical trial or qualify. Compassionate use requires very low income limits.

My brothers response to this question was; "They die, thats what happens to them!"

The rich dont have to worry and the government covers the poor but what about the middle class? You could work your butt off your whole life and do everything right and yet this happen to you. "There but by the grace of God go I." One illness and a lifetime of work and savings wiped out. Got to be a better way but I don't have the answers.

 

[True Grit Farms]

Something else to consider: hospitals(ERs) are forced to treat whatever walks through the door, regardless of if they have insurance or means to pay the bill. When a significant portion of your clients can not pay the bill, like every other sector in business, guess who it gets passed on to? That's correct, those who can pay. Just like taxpayers that pay the cost for many that can't, won't or don't pay taxes, but still draw the benefits.
I will give you an example. A middle aged man walks into the ER complaining of abdominal pain. He has no insurance and is a self pay customer. His ER work up includes lab draws, abdominal imaging, some IV fluids, perhaps some Zofran for nausea. Imaging reveals he has a perforated bowel and needs emergent surgery. The surgery crew is called in, his surgery is completed and he is admitted inpatient to Med/Surg unit for 3 days post op recovery antibiotics, IV fluids, etc. The ER bills, coupled with his surgery and inpatient bills is substantial as anyone who has been hospitalized well knows. But this gentleman isnt going to pay because he cant. Even if he had Medicare or Medicaid, the reimbursement would barely be a break even for the hospital. If our pt in the scenario complains about any aspect of his visit, reimbursement becomes even less. So who eats this substantial bill? The hospital, ER physicians group and Surgeons group. The same folks that have to pay staff, maintain equipment, building and all the expenses it takes to maintain a facility, not the least of which is insurance of several varieties (fire, malpractice, etc.)

In the above scenario, if the surgery was determined to be non emergent, then the hospital only has to eat the ER work up(still a good chunk of cash) because as an ambulatory or scheduled inpatient procedure, the hospital can collect some payment before the procedure or decline to provide service if payment arrangements can not be made.

I am here to testify, as someone who manages a mid level hospital after normal business hours, this type of scenario occurs very regularly. Small hospitals are closing or consolidating across the nation, mid levels are consolidating or fighting for their existence, even the large operations aren't churning out a tremendous profit in many cases.

These types of occurrences eventually are written off as losses because of inability to collect. No successful business can function for long taking losses.

Just something to consider.

Thank you for the effort to post that. You may know if this is true - I had a friend in Helena Montana who was a Pediatrician. He claimed doctors do not make as much as public perception. Considering the cost of a practice, malpractice insurance, etc. He like to tell me that I made more than he did.

You very well might of made as much, but did you live the same lifestyle? I play golf with a few doctors regularly and I'm amazed at the lifestyle they live.