Looking at Medical Costs

Susan Handelsman offers this advice:

How to protect yourself and others from your health insurance, hospital, and Congress

Want to use time off productively?

Learn about the deliberately overpriced, inefficient and destructive (to patients and providers)  healthcare system that we all have allowed to take complete power over most of  our lives and deaths.

Health insurance companies can raise profits one way only: increase their revenues (not, as one might assume, by decreasing expenditures to providers).

Medical Loss Ratio (MLS) limits profits and administration to 20% of revenues (premiums paid by clients or government).

Therefore, the more insurance companies pay out, the more they are allowed by law to earn in profits.

There are virtually no regulators allowed to see insurers’ cost information let alone regulate it (because most health insurance revenues are now generated by their new RISK-FREE status as third-party benefit administrators, who earn monthly fees from government and employers to administrate– and set reimbursement rates, affecting co-pays!!–for most of the healthcare services provided in this country).

Competition?

Not allowed.

Stark Laws tie doctors hands from offering far more reasonably-priced competitive services,  and politically controlled Certificates of Need are required in Illinois to protect any threat to hospital monopoly power.

Meanwhile, Federal Anti-Kickback Laws have a safe-harbor provision for GPOs (group purchasing organizations) and to a certain degree PBMs (pharmacy benefit managers).

PBMs and GPOs are paid according to the same incentives as private health insurance companies: the higher the cash flow  the higher their profits.

There is zero incentive for these middlemen to lower costs to the end users.

Accordingly, they develop formularies and deal with exclusive providers based upon how big their personal kickback will be. 

As we are now seeing, the monopolistic destruction of possible competitors producing hospital commodities like masks or saline bags has a murderous effect when a pandemic emergency occurs.

Who is to blame and what can we do about it?

We, the patients are to blame.

We don’t pay attention and allow ourselves to be divided along nonsensical partisan political lines…when there is really only ONE political party protecting this freakshow now and it is a party to which we taxpayers and human bodies seeking healthcare  are not invited, we are on the menu.

What can we do now?

1. EVERY time you get a prescription for a drug, call around to at least 3 pharmacies for price comparisons (cash payer price, vs. GoodRx price, vs your co-pay with your particular ‘insurance’).Costco is often the lowest priced for cash payers. The pharmacists don’t like it? Too bad. They can easily POST PRICES ONLINE as alternative. They leave us no other option.

If you feel the risk is warranted, buy medications overseas. Many are not manufactured here: producers in Ireland sell the identical product to USA and Canada (although in Canada at less than half the price).What are the risks? You may be the test case for Federal prosecution forbidding Americans who cannot afford medication in America to import it. You may be buying adulterated, or counterfeit medications. You may not be able to sue if you have an adverse reaction to your medications. The risks are profound but so are the alternatives (not being able to afford medications).

2. EVERY time you are prescribed a test (radiology  imaging, serum testing) call around  for price comparisons (cash payer price at hospital, your insurance co-pay at your hospital, independent MRI and blood testing labs, a doctors office). Try to NEVER go to a hospital for an elective diagnostic test as your co-pay will frequently be significantly higher than your cash price at an independent testing center.

3. EDUCATE yourself online, about this healthcare cost crisis so devastating to so many of your fellow Americans. Twatting that you hate Trump or Pelosi does not fulfill anyone’s civic duty. If you cannot make the effort to learn what is happening, at least refrain from voting for predatory sociopaths who enabled the current circumstances and who now fight fiercely to defend it from disruption.

http://truecostofhealthcare.org/  (David Belk M.D.)

https://stanmed.stanford.edu/2017spring/how-health-insurance-changed-from-protecting-patients-to-seeking-profit.html  From An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal, published by Penguin Press, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC.


Comments

Looking at Medical Costs — 48 Comments

  1. And yet, according John Hopkins data, Wednesday was the deadliest day yet for the US with 233 fatalities reported, taking the US to 65,273 cases and 938 deaths. In New York and California, the number of confirmed cases is doubling every few days.

    Who you gonna call?

  2. Stephen Pokorny, evidently has a lot of time on his hands.

    He has nothing to do but make snarky remarks on this blog.

    Take a hike Stephen!

  3. I’m going to hike right over to your house and give you a big fat kiss.
    And do tell, what’s the difference between what I do and what you do?
    I do this for amusement. You do it for validation.

  4. Pokorny, I don’t need anyone’s validation.

    You are not welcome at my residence.

  5. Sure you do, but I suppose your wife Cindy would get insanely jealous.

  6. Susan advice:

    “EVERY time you are prescribed a test (radiology imaging, serum testing) call around for price comparisons (cash payer price at hospital, your insurance co-pay at your hospital, independent MRI and blood testing labs, a doctors office). Try to NEVER go to a hospital for an elective diagnostic test as your co-pay will frequently be significantly higher than your cash price at an independent testing center.”

    Not so sure about calling around, shopping around. Medical issues are not like shopping a good price for a car or tv or refrigerator. IF you have a good insurance plan and have had good experiences, including reasonable costs, at a particular hospital and/or its branches, stick with them.

  7. Eric C,

    STALKING AND HARASSMENT IS A CRIME IN THE STATE OF ILLINOIS!

    You have no credibility!

    Knock, Knock, the Police were at your door!

  8. Eric C,

    YOU CAN RUN BUT YOU CAN’T HIDE!

    WE KNOW WHO YOU ARE, AND YOU ARE IN BIG TROUBLE!

  9. Knock, Knock, who loves to live in the Misty Woods?

    The birds on a Twigg singing Crazy Lady!

  10. BredW:
    Evidence-based examples cited by David Belk MD (from his own medical practice) on
    Truecostofhealthcare.org make it clear that:

    Shopping around IS possible and frequently produces significant savings

    Buying pharmaceuticals using health insurance (co-pays) is frequently MORE expensive than paying full cash prices (due to perverse PBM incentives).

    There are no “reasonable ” prices in third party controlled healthcare, and remaining willfully ignorant harms everyone in society.

  11. The birds on the Twigg are stalkers! They have nothing better to do but create problems wherever they go.Your game is over, we know who you are. SICKOS!

  12. DALA IS SINGING PETITION NO STALKING ORDER! Your buddy from out of State has a lot of explaining to do. Last time he was in the State he was interrogated by the McHenry County Sheriffs Department. Those birdies are defined by the company they keep!

  13. Stalker Eric! You are not invincible. You have always been a loser and always will be!

    You are truly pathetic!

    Last time your buddy was in Illinois, he was interrogated by the McHenry County Sheriffs Office!

    Poor baby, he got scared!

  14. If you listen carefully, you can hear the children on the street singing Crazy Lady.

  15. Eric is a real sicko, who is so miserable that other peoples lives are more important.

    Karma, will come back to get you.

    In fact, you could get cancer or the Carrona.

    We can only hope.

  16. Or, maybe someone else in your family got cancer or the Caronna and died.

    News flash, KARMA!

    Now you just have to realize it.

  17. Eric C, doesn’t like Sheriff Prim Either.

    He’s the same guy who did research in an attempt to find dirt on Mat McNamara causing him to leave the McHenry County Sheriffs Department.

    Eric is a fool who wants to be everyone’s hero.

    But the truth is Eric is a “COWARD” who loves to run when things get tough.

    ERIC C IS A COWARD and a RUNNER!

    http://mchenrycountyblog.com/2014/10/06/harrisons-former-campaign-manager-supports-prim-for-sheriff-i-saw-both-sides/

    ERIC C WILL NEVER BE A HERO!

  18. The truth needs to be told about what Eric C did to Mat McNamara and Mickey Schuch.

    He was working behind the scenes and doing research to sabotage Sheriff Prim.

    You see Eric and Prim had a tif and instead of Eric laying down his weapons he went into retaliation mode to get even with Sheriff Prim.

    Eric C is the guilty culprit who did research on McNamara, so he could use the information to get him fired.

    He used other people to get the information, without telling them who he was researching and what he was going to use the information for.

    Eric C, creates problems every time he runs to a new community.

    He is, in fact, is one of the most passive aggressive people you will ever meet in your lifetime.

    Eric C, is truly a pathetic and lost soul!

  19. NEWS FLASH, MATT MCNAMARA AND SHERIFF BILL PRIM!

    ERIC C NEEDS TO BE RUN OUT OF TOWN!

  20. WOW, I hit a nerve!

    I read your link; you sound a lot like Duncan Mchenry, and we all know who Duncan is.

    You stated:

    “Or, maybe someone else in your family got cancer or the Caronna and died”.

    “In fact, you could get cancer or the Carrona”.

    “We can only hope”.

    This is the reason why we can hear the children on the streets singing Crazy Lady.

  21. Eric C, you absolutely have issues. Normal people don’t stalk others when they are told to stop. Then again, Eric C, is not normal.

  22. It is obvious that you are having a hard time as your mind is spinning out of control.

    Whatever the Doctors are doing for you is not working.

    Turn to God to control your demons.

  23. Eric, you better control your flying monkeys.

    Monkeys live in the jungle.

  24. Find peace within yourself and embrace the Lord to control your demons.

  25. Eric you are a nut. Trying to turn the tables on me when you have big issues. But then again thats what NARCS like you do. You belong in the jungle. Stay there.

  26. Don’t you have a coffee table to fix or something? Please for everyone’s sake don’t lose your temper!

    Eric, holds grudges and doesn’t let go.

    Nope!

    He hangs on for dear life!

  27. Eric, started throwing temper tantrums as a young child. Now, he’s an adult and he still throws temper tantrums.

  28. “holds grudges and doesn’t let go”

    You are the last of all that should speak of grudges, YOU still wine about the Nygren Regime.

    But that’s your illness talking for you bonehead.

  29. Eric, your game is over. Now go back to your Jungle live your life and stop bothering other people. Most of all, get a grip on your vindictive anger. It’s time for you to stop acting like a 2 year and stop blaming the rest of the world for your problems, especially when you are the reason for your problems. You need to face the fact that you are not a HEROE and will never be a HEROE. The only thing you will be remembered for is your ridiculous temper and your need for, vindictive, retaliation of others. So do everyone a favor and go burn your batman costume. It’s time to grow up!

  30. DALA LALA seems to be the one here who can’t let go.

    what a not job.

    Are you sure your alter ego isn’t Cindy

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