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The Fine Print: The following comments are owned by whoever posted them. We are not responsible for them in any way.
byretroworks ( 652802 ) writes:
This is very worrisome, glad to see it being discussed. According to the USA Bureau of Labor Statistics, health care employment accounts for (by far) most of the growth in jobs in the USA http://www.bls.gov/oco/cg/cgs035.htm [bls.gov]. What happens when a new sport surgeon opens an office in your county? What happens when a urologist opens an office in a town of 10,000 residents? The free market says that when people take employment providing a "service" which they themselves are empowered to prescribe, that prescription rates increase proportionately to the wages.
I realized this when I broke my arm in almost precisely the same place, in almost exactly the same way. The first time it was a reset, an X-ray, and a cast. The second time, a new Osteopath building had been opened in town, with two new very smart and very nice doctors. Good people. Outcome was surgery, metal plates, screws, therapy, etc. My insurance paid for both treatments, but I got to see the bills. The second broken arm was over $10,000 more expensive than the first time. And when I read about the dangers of putting people under anesthesia, I really wonder how the risk was weighed against the benefit of making payments on the new doctor's office. I'm not grossly cynical about the health industry, but whenever a field of the economy becomes too respected (think Catholic Church), people begin to assume the best, and that's a recipe for problems.
By the way, there is a new Urologist in my town of 10,000, with a lovely office. He just told my wife that both our sons need teen circumcision, under anethesia. What is really worrisome is that the USA's aging population makes for an almost infinite number of diagnostic tests, etc., for these people to fill. If the government paid for car repairs, we'd have lots of mechanics and lots of repairs.
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byAnonymous Cowar ( 1608865 ) writes:
If the government paid for car repairs, we'd have lots of mechanics and lots of repairs.
That's a really long way to go for a car analogy.
by0123456 ( 636235 ) writes:
That's a really long way to go for a car analogy.
Not true; I'm sure we've all heard stories from family members about taking their car to a mechanic and being told it needs half a dozen repairs that it really didn't. Medicine is the same, expect most people have insurance so they don't even have to think about whether the extra 'repairs' are needed because they're not paying for it.
byTubeSteak ( 669689 ) writes:
That's a really long way to go for a car analogy.
It's also wrong.
By itself, the Federal Government has the single largest fleet of vehicles: 600,000+
When you add in vehicles owned at the State/County/Local Government level, the numbers start getting much bigger.
Think 50 States worth of public transportation, national guard, police, public works, and fleet vehicles for the bureacrats
byDrgnDancer ( 137700 ) writes:
The second broken arm was $10,000 more than the first, but the first "treatment" resulted in your arm breaking in exactly the same way a second time. Don't get me wrong, there are a ton of factors involved in the location and severity of a bone break, and it may well have been inevitable that your arm would break the same way when you injured yourself in a similar manner; *but* it's also arguable that the less elaborate and complete first treatment resulted in the bone healing weaker and more likely to rebreak.
Regardless of whether the first break contributed to the second, it's also not inconsiderable that getting such a similar injury in nearly the same place caused the doctors to have to take much more care in the second treatment. Having two healed breaks, practically on top of each other, is almost certain to weaken the bone; the addition of some titanium plated for support of such a weakened bone might have been prudent caution.
You also mention therapy, which is certainly a not inconsiderable expense but can significantly increase the pace of recovery. It may not make you any stronger or healthier in the end, but the "end" might be 8 weeks instead of 12.
I'm not a doctor of course, and I don't know the details of your case, but in my mind your having had two such similar breaks is an excellent argument for the second being more expensive. Now the urologist thing does seem a bit suspect, but again, it's hard to say. Is your son experiencing some sort of symptoms that such an operation might alleviate?
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byretroworks ( 652802 ) writes:
All good points, DrgnDancer. It may well be that the second broken arm procedure was necessarily more expensive, it may well be that I have two sons requiring teen circumcision. It is also a valid point that in a litigious society that doctors have a very good reason (or excuse) to err on the side of more diagnostic tests and more expensive procedures. I'm unhappy with the complications and skeptical of the justification for the surgery, but it's just a single anecdote.
I found this 2009 NPR story on how a
byDrgnDancer ( 137700 ) writes:
Indeed, I was not trying to say that "Doctors are always right" either. Like anything else, you have to evaluate the facts and make a decision. Those facts include the expert opinion of your doctors; but like everyone else they are human and they err. In my mind the treatment on your arm is a bad example. There are a number of factors that could have led to a very similar seeming injury requiring very different treatment, or for a specialist to recommend a more elaborate treatment than a generalist (tha
bysjames ( 1099 ) writes:
...and that no field should be considered immune from self-interest.
That also includes unintentional self interest. A doctor is naturally going to have a bias towards medical intervention, even if they don't benefit financially. It's just human nature.
It's a less extreme form of "give a man a hammer and the world will look like a nail".
We have long, hard, and well thought out programs to impart medical knowledge, but not a lot to impart medical wisdom.
byironjaw33 ( 1645357 ) writes:
Don't get me wrong, there are a ton of factors involved in the location and severity of a bone break, and it may well have been inevitable that your arm would break the same way when you injured yourself in a similar manner; *but* it's also arguable that the less elaborate and complete first treatment resulted in the bone healing weaker and more likely to rebreak.
As a kid, my wife broke her arm twice in the exact same place. The doctors told her that she would need metal plates and screws if she did it a third time, for the arm wouldn't heal properly without such a treatment. 25 years later, she still feels occasional pain in the area where the arm broke.
bytwebb72 ( 903169 ) writes:
I'd probably side with the doctors on this one. I've broken my collar bone several times, the the first time is nothing like the third. Each time, bone is weaker, and structurally, its fubar. Each additional break causes more and more structural and nerve problems (i get the occasional pain *PANG* from bending in the wrong direction).
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bytkprit ( 8581 ) writes:
I've seen the phenomenon when a local specialist merely upgrades his office with new diagnostic testing equipment. Suddenly everyone needs a bone scan, or a 'routine' endoscopy, &c silly ass tests that have nothing to do with why the hell you went in to the specialist. (Of course the specialist says it's a "service" for his/her patients, so we don't have to drive 20 mts away to have a 'beneficial' test done. But I bet you the specialists recommend the testing a lot more after they install the new equipm
bydemonlapin ( 527802 ) writes:
He just told my wife that both our sons need teen circumcision, under anethesia
They're obviously having some sort of problem - else why would you have gone to see him? Mechanical problems with urine flow require mechanical solutions.
I've seen lots of patients who've been subjected to defensive medicine, and some that were definitely subjected to a wallet biopsy. But what you're describing is actually pretty good medicine - first minor break, attempt a conservative, nonoperative solution; second break, seek definitive treatment.
byaccount_deleted ( 4530225 ) writes:
Comment removed based on user account deletion
bykbielefe ( 606566 ) writes:
Stuff costs money because there isn't enough stuff for everyone to have as much as they want. Breathing air is free because there's plenty of it. Land and water used to be free until things became crowded enough that communities had to make trade offs. Radio broadcasts and a lot of software is free because making additional copies of it has negligible cost and there are people willing to bear the cost of making the first copy.
Health care costs money because there's not enough available for everyone to ha
byNicBenjamin ( 2124018 ) writes:
The way around this is called capitation payment.
A Doctor gets a patient he gets a lump sum. He gets 100 patients, one of whom is really sick, he spends most of his money on the sick guy.
It works pretty good in the UK, which has the most cost-effective system in the industrialized world, but it's unlikely to appear here because it's doubtful anyone has the power to make physicians change their billing systems.
bySwave An deBwoner ( 907414 ) writes:
The way around this is called capitation payment. A Doctor gets a patient he gets a lump sum. He gets 100 patients, one of whom is really sick, he spends most of his money on the sick guy.
And what happens when the second guy gets really sick? Or the third?
Doctor waits until payment is approved before treating them? That's basically how a good friend of mine died of CLL when his initial chances of recovery were very high.
bySwave An deBwoner ( 907414 ) writes:
Umm, that should have read "CML".
byNicBenjamin ( 2124018 ) writes:
Approval?
You don't seem to understand the system, probably because I explained it poorly. Here's what happens, with round numbers 'cause I suck at math. A Doctor has 2,000 patients covered by the plan. He get's $2,500 per patient. Out of that $5,000,000 budget he approves every treatment, pays his receptionist, himself, nurses, etc. There's no need to call the insurance company. As long as the capitation rate is high enough to cover necessary medical care everybody gets everything they need.
The advant
bySwave An deBwoner ( 907414 ) writes:
There was no problem with your explanation, my problem is that the "capitation rate" is never "high enough" because the folks who determine the rate are trying to squeeze the budget. So instead of squeezing it on a per-procedure level (like with Medicare in the US), it gets squeezed on a "per patient" level based on statistical (un)certainty as to how many model patients will require {no, little, much, extraordinary} amounts of treatment. So while it may work out over the global population, there's a big
byNicBenjamin ( 2124018 ) writes:
Re-read my original post.
I was claiming capitation reduces the number of unnecessary medical procedures by removing doctor's incentive to prescribe them. That's the advantage of a capitation-based system.
As for whether it's possible to fund any system enough that the problem you mention goes away for all 6 billion humans, the answer is of course not. Criticizing a medical funding system for that flaw is like criticizing the Ford Focus's inability to ignore inertia. Yes it's true the Focus has inertia,
bySwave An deBwoner ( 907414 ) writes:
I was claiming capitation reduces the number of unnecessary medical procedures by removing doctor's incentive to prescribe them.
You have no argument from me there.
In my opinion, capitation also likely reduces the number of necessary medical procedures because it does not merely remove a doctor's incentive to prescribe them, it financially penalizes the doctor for prescribing them. The more procedures done, the less money left in the doctor's (or hospital's) pocket.
That's the advantage of a capitation-
byAmericium ( 1343605 ) writes:
Growth in the Medical field should lead to lower prices, just like growth in any other field leads to lower prices and higher quality in that field, be it energy production, electronics, farming, mining, internet access and services, or whatever. Just measure prices in inflation adjusted prices.
Prices are high because Medical insurance is screwed up. You get tax breaks on it if you employer pays, which leads to many problems. First, people try to get more of their income in benefits, since it's the tax code
bySycraft-fu ( 314770 ) writes:
If your goal was to keep your car for as long as you could, and have it run as good as it could, you'd take it to the mechanic often. You'd take it in at least once a year, more as it got older, just for a basic checkup and tune up. This wouldn't be because anything was wrong with it, just to try and catch things early. You'd also take it in any time there was something even slightly off. Like if it had a noise it didn't before, or its handling was different or any of that. You'd get a lot of service done o
byWalkingshark ( 711886 ) writes:
Please don't let that quack mutilate your kids.
byMean Variance ( 913229 ) writes:
By the way, there is a new Urologist in my town of 10,000, with a lovely office. He just told my wife that both our sons need teen circumcision, under anethesia.
May I ask why he said your teen sons need to be circumcised?
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