US Birth Rate

[Bullneck 18983]

Just now, royiv said:

Didn’t do it. 

Interesting.  I've heard medical bills being sold to collection agencies who hound people (sometimes using illegal means) forever.

[David Dennison 18646]

1 minute ago, royiv said:

Didn’t do it. 

But many do. Medical bankruptcies are real.

[ChiTownDoc 21097]

1 minute ago, chainsaw said:

No, it is the profit (greed) motive inefficiently allocating a vital resource because the population served is too rich for government assistance but too poor to be a profit center. If the government were unshackled and allowed to directly participate in the market for providing healthcare services there would be fewer healthcare deserts.

Greed gets us to a point where the California has to step in and start producing its own affordable insulin.

No.  Policy like Texas not accepting Medicaid dollars.  My group accepts Medicaid in all states and we are not primary care. We are in 43 states.  

[chainsaw 9836]

On the subject of birth rate

https://www.parents.com/pregnancy/everything-pregnancy/interactive-map-shows-cost-of-childbirth-around-the-world-and-its/

[chainsaw 9836]

1 minute ago, ChiTownDoc said:

No.  Policy like Texas not accepting Medicaid dollars.  My group accepts Medicaid in all states and we are not primary care. We are in 43 states.  

Medicaid is not a fundamentally capitalist idea. I'm glad your group accepts Medicaid, and I would even bet you are happier to deal with it as a payor than a private insurer.

Texas has dogshit policy, on this we agree. But the so-called free market is not doing a good job of allocating vital healthcare resources. Texas is theoretically more "free" of a market because it has less government intervention, and you're saying Texas has worse healthcare despite having some of the best doctors on the planet.

[royiv 9145]

2 minutes ago, Bullneck said:

Interesting.  I've heard medical bills being sold to collection agencies who hound people (sometimes using illegal means) forever.

Yeah, it’s definitely a thing. It’s a lot more common with shitty ER groups. Should become less common in the future with the implementation of the No Surprises Act at the beginning of this year. The ones left vulnerable are the uninsured. If TX would expand Medicaid that would do a lot of good in decreasing that population.

[chainsaw 9836]

8 minutes ago, David Dennison said:

But many do. Medical bankruptcies are real.

Not only real, the driving force behind financial ruin

https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html

[Judge Roybeanbag 11802]

17 minutes ago, troph said:

Impediments to progress, they hate humanity and the planet, they want to rule not govern.

This is correct, we have a problem where the folks in office feel entitled, and the electoral and gerrymandering system we have in place makes it worse.  

[ChiTownDoc 21097]

5 minutes ago, chainsaw said:

Medicaid is not a fundamentally capitalist idea. I'm glad your group accepts Medicaid, and I would even bet you are happier to deal with it as a payor than a private insurer.

Texas has dogshit policy, on this we agree. But the so-called free market is not doing a good job of allocating vital healthcare resources. Texas is theoretically more "free" of a market because it has less government intervention, and you're saying Texas has worse healthcare despite having some of the best doctors on the planet.

States that are too far left have serious issues and same with those that are too far right.  Too far left is definitely the lesser of two evils.  Again, healthcare policy is a disaster overall but the healthcare system here is great if it were to be unencumbered.  

[StassneyHorn 6535]

Started with this, https://www.texastribune.org/2020/06/25/texas-hispanic-population-grows-2-million/amp/

Fueled by this,

Led to this,

Texas Walmart shooting: El Paso gun attack leaves 20 dead

https://www.bbc.com/news/world-us-canada-49221936.amp

Yadda yadda yadda, replacement theory.

 

[Judge Roybeanbag 11802]

1 minute ago, ChiTownDoc said:

States that are too far left have serious issues and same with those that are too far right.  Too far left is definitely the lesser of two evils.  Again, healthcare policy is a disaster overall but the healthcare system here is great if it were to be unencumbered.  

But unencumbered means some brown or less than white person might get something I didn’t get!  Fuck that!

[chainsaw 9836]

2 minutes ago, ChiTownDoc said:

States that are too far left have serious issues and same with those that are too far right.  Too far left is definitely the lesser of two evils.  Again, healthcare policy is a disaster overall but the healthcare system here is great if it were to be unencumbered.  

We have all the ingredients for a utopian healthcare system. We have the equipment, facilities, capacity to produce drugs, practitioners, everything. The infrastructure is in place. It's gummed up by useless middlemen and perverted by greed.

It's like having Top 5 recruiting classes every year, the best facilities money can buy, and the best conditioning program, and still going 7-5 and losing your bowl game because we have an idiot calling the plays and for some reason we are fanatically devoted to that idiot. Or it's like having Jerry Jones running everything.

[ChiTownDoc 21097]

13 minutes ago, chainsaw said:

Medicaid is not a fundamentally capitalist idea. I'm glad your group accepts Medicaid, and I would even bet you are happier to deal with it as a payor than a private insurer.

Texas has dogshit policy, on this we agree. But the so-called free market is not doing a good job of allocating vital healthcare resources. Texas is theoretically more "free" of a market because it has less government intervention, and you're saying Texas has worse healthcare despite having some of the best doctors on the planet.

They pay like shit but we aren’t assholes so we take it.  Also have to wait forever in many states sadly.  We need to close out of network bullshit etc.  Lots to fix here but it’s still a great system if/when implemented properly.  

[ChiTownDoc 21097]

Just now, chainsaw said:

We have all the ingredients for a utopian healthcare system. We have the equipment, facilities, capacity to produce drugs, practitioners, everything. The infrastructure is in place. It's gummed up by useless middlemen and perverted by greed.

It's like having Top 5 recruiting classes every year, the best facilities money can buy, and the best conditioning program, and still going 7-5 and losing your bowl game because we have an idiot calling the plays and for some reason we are fanatically devoted to that idiot. Or it's like having Jerry Jones running everything.

Same page in the end…

[chainsaw 9836]

Just now, ChiTownDoc said:

They pay like shit but we aren’t assholes so we take it.  Also have to wait forever in many states sadly.  We need to close out of network bullshit etc.  Lots to fix here but it’s still a great system if/when implemented properly.  

Is it unprofitable, or is it simply less profitable than private pay? Because if the former why would you do it, and if the latter, it's those excesses that are responsible for the inefficiencies in our system and indirectly responsible for the glut of bankruptcies caused by medical bills.

[ChiTownDoc 21097]

3 minutes ago, chainsaw said:

Is it unprofitable, or is it simply less profitable than private pay? Because if the former why would you do it, and if the latter, it's those excesses that are responsible for the inefficiencies in our system and indirectly responsible for the glut of bankruptcies caused by medical bills.

It’s definitely unprofitable.  And most docs have as many patients as they want so it’s even worse when you consider that.  Again, it’s a policy because it’s the right thing to do and it’s still a very small percentage of our overall practice. 

[chainsaw 9836]

1 minute ago, ChiTownDoc said:

It’s definitely unprofitable.  And most docs have as many patients as they want so it’s even worse when you consider that.  Again, it’s a policy because it’s the right thing to do and it’s still a very small percentage of our overall practice. 

Is it possible to turn a profit? Like if you were starting a practice from scratch and kept overhead as low as possible, would the reimbursement exceed the overhead? I get that the salary you pay yourself would likely be below market but suppose "opportunity cost" is out of the equation, would you be able to live comfortably and provide adequate care with Medicaid as the only payor?

If the answer is "no" I would question why it is and I strongly suspect that the reimbursements are too low (which can be fixed with adequate funding, which can be fixed by taxing the ultrawealthy) and that certain expenses are too high (which likely is due to the greed of other market participants and can be fixed the way Gavin Newsom intends to fix the insulin pricing problem).

[safe sex 11676]

1 hour ago, royiv said:

That's actually good to hear as I was flabbergasted by how bad the NHS hospital was. Old, outdated facilities, lots of patient safety issues, poor medication management, etc. I had always heard great things about NHS so it was something that was really surprising to me. 

The Tories have spent decades slowly tearing down the NHS and its ability to provide high quality care. It's been gutted for a long time now. 

[Judge Roybeanbag 11802]

The system we have is untenable except for the status quo.  If you don’t want it to affect you when it’s shaken up, plan accordingly.  After all that’s what I get told about my retirement.  Too bad sucker, your 401k just shit the bed when you were 59.5.  Haha you should have planned better.  Plebe.  I’m not going to feel sorry for anyone in any industry when we finally do the right thing as a country.   You still have your goddamned bootstraps, use them. 

[Fudge Nuggets 19144]

2 hours ago, Sawbonz said:

Unless they need an actual surgery for a non impending life threatening condition

Wrong.

My aunt was in a car wreck in Germany and messed up her shoulder.  She had surgery done over there to fix it which apparently there were only three surgeons in the US qualified to carry out the same procedure.  Cost her $450.

[ChiTownDoc 21097]

1 hour ago, Bullneck said:

Interesting.  I've heard medical bills being sold to collection agencies who hound people (sometimes using illegal means) forever.

I definitely don’t think that’s the norm.  Of course those few examples will be put on blast, like the likely should be.  

[ChiTownDoc 21097]

47 minutes ago, chainsaw said:

Is it possible to turn a profit? Like if you were starting a practice from scratch and kept overhead as low as possible, would the reimbursement exceed the overhead? I get that the salary you pay yourself would likely be below market but suppose "opportunity cost" is out of the equation, would you be able to live comfortably and provide adequate care with Medicaid as the only payor?

If the answer is "no" I would question why it is and I strongly suspect that the reimbursements are too low (which can be fixed with adequate funding, which can be fixed by taxing the ultrawealthy) and that certain expenses are too high (which likely is due to the greed of other market participants and can be fixed the way Gavin Newsom intends to fix the insulin pricing problem).

Medicaid varies a LOT state to state.  In my specialty in IL you’d be broke and unable to run a practice on Medicaid.  We were getting $16 a visit a just a few years ago.  Have you tried hiring anyone lately?  Yikes

[chainsaw 9836]

Just now, ChiTownDoc said:

Medicaid varies a LOT state to state.  In my specialty in IL you’d be broke and unable to run a practice on Medicaid.  We were getting $16 a visit a just a few years ago.  Have you tried hiring anyone lately?  Yikes

How much would it need to be funded to turn a livable profit? 

[Sawbonz 27392]

Last I checked in texas Medicaid paid 80% of Medicare,  and Medicare only will put you out of business as a PCP unless you are running several NP’s and PA’s and they are at capacity or unless a hospital or other larger entity that can capture ancillary revenue based on your work is subsidizing your salary. I have encouraged my kids, all very bright, to stay away from medicine

[chainsaw 9836]

2 minutes ago, Sawbonz said:

Last I checked in texas Medicaid paid 80% of Medicare,  and Medicare only will put you out of business as a PCP unless you are running several NP’s and PA’s and they are at capacity or unless a hospital or other larger entity that can capture ancillary revenue based on your work is subsidizing your salary. I have encouraged my kids, all very bright, to stay away from medicine

Seems like an indictment of capitalism to me.

[ChiTownDoc 21097]

8 minutes ago, chainsaw said:

How much would it need to be funded to turn a livable profit? 

It’s very complex but for a typical follow up visit you’d need $55 I’d guess.  Our average collection per encounter is $74.  We do a couple million a year so we run on small margins - and good outcomes.  A lot of at risk plans.  Also at risk can be a cluster fuck.  We backed out of many ortho joint bundles because the payers denied proper rehab - I’m sorry but some people need inpatient skilled rehab for a few days.  Sawbonz probably sees some of that in his neck of the woods.  

[chainsaw 9836]

Just now, ChiTownDoc said:

It’s very complex but for a typical follow up visit you’d need $55 I’d guess.  Our average collection per encounter is $74.  We do a couple million a year so we run on small margins - and good outcomes.  A lot of at risk plans.  Also at risk can be a cluster fuck.  We backed out of many ortho joint bundles because the payers denied proper rehab - I’m sorry but some people need inpatient skilled rehab for a few days.  Sawbonz probably sees some of that in his neck of the woods.  

I think a sane taxation scheme could easily cover $74 per visit, adjusting quarterly for inflation. Especially if we got rid of administrative bloat. We should not be tolerating a system where greed deters bright youths from doing what they want to do and providing what the public needs.

[Neonmoon 38127]

How do all the other counties make single payer work? 

[ChiTownDoc 21097]

2 minutes ago, chainsaw said:

I think a sane taxation scheme could easily cover $74 per visit, adjusting quarterly for inflation. Especially if we got rid of administrative bloat. We should not be tolerating a system where greed deters bright youths from doing what they want to do and providing what the public needs.

We don’t do high end procedures etc but yes it can be done.  There’s a lot of assholes scavenging the system just to make a buck.  Giving zero fucks about patients or the care they deliver.  

https://blockclubchicago.org/2021/04/28/cash-strapped-loretto-hospital-paid-millions-to-companies-formed-by-ousted-executives-pal/

Like these POS who I literally got into a fight with at a restaurant over some bullshit schemes they run.  I’m not proud of it, but I’ve always said I’m an unapologetic asshole.  

[jimmyjazz 45538]

2 hours ago, RomaVicta said:

I can imagine not having children. I have none. It's just as great.

Actually, you have less ground to stand on than I do in that regard.  I didn't have a kid until age 39, so I am well aware of what it's like to go through college, young professional, and then exploding professional responsibilities without a kid.  Then again, I also know what it's like to have a kid.

You don't.

That doesn't make me better, but I have much more experience than you.

[chainsaw 9836]

2 minutes ago, ChiTownDoc said:

We don’t do high end procedures etc but yes it can be done.  There’s a lot of assholes scavenging the system just to make a buck.  Giving zero fucks about patients or the care they deliver.  

https://blockclubchicago.org/2021/04/28/cash-strapped-loretto-hospital-paid-millions-to-companies-formed-by-ousted-executives-pal/

Like these POS who I literally got into a fight with at a restaurant over some bullshit schemes they run.  I’m not proud of it, but I’ve always said I’m an unapologetic asshole.  

I think people like you may not be outnumbered, but you are outgunned. And the status quo incentive structures are warding off people who get into medicine for the right reasons while attracting dumbasses who don't.

I used to think it was fixable by adjusting the knobs of the market, regulating more, that sort of thing. But now I realize that perverse incentives will always be many, many steps ahead of the rules. The only ones getting paid are the expensive lawyers who figure out how to help the bastards screw the little guy.

You can shuffle things around, but nothing will actually change for the better until Jerry Jones is gone.

[Captainant 27405]

2 hours ago, ChiTownDoc said:

Again, many do.  Not where you’re from.  NW let’s a fuckload just go, if we are talking the other end of the spectrum from Cook County.  Also as stated many times, the taxpayer ends up paying.  My property taxes in Cook this year - 180k.  Nobody is locking you up after you get some junk mail.  Quit obfuscating. 

Lol, one of my groomsmen got a $50k bill from a hospital for a 1hr ER visit after a car accident. He got chased for 18 months by the hospital and eventually got them to accept $1500 to fuck off and consider things settled. The taxpayer pays a bunch, including the poor downtrodden multimillionaires like yourself, but I can assure you that for the people receiving the care, they frequently face impossibly and illogically large bills. 

You're the one obfuscating, refusing to acknowledge that there's significant barriers for access for basic human care

Edited July 10, 2022 by Captainant

[ChiTownDoc 21097]

4 minutes ago, Captainant said:

Lol, one of my groomsmen got a $50k bill from a hospital for a 1hr ER visit after a car accident. He got chased for 18 months by the hospital and eventually got them to accept $1500 to fuck off and consider things settled. The taxpayer pays a bunch, including the poor downtrodden multimillionaires like yourself, but I can assure you that for the people receiving the care, they frequently face impossibly and illogically large bills. 

You're the one obfuscating, refusing to acknowledge that there's significant barriers for access for basic human care

As I said, that’s the exception.  Sorry it happened to your friend.  I can assure you I have a fuckload more experience than ‘one of my friend’ stories.  We are probably with thousands of plans and healthcare systems.  But really sad story.  Thanks for sharing.  It doesn’t give you equal footing in this conversation.  

[Sawbonz 27392]

28 minutes ago, chainsaw said:

Seems like an indictment of capitalism to me.

Medicare and Medicaid fee schedules are set by law. There is no negotiation; take it or leave it. The system relies on the good heartedness of providers to take care of these patients although it costs the practice money to see them. That is not capitalism. And I’m not really sure where you are going with this anyway as no one on this thread is advocating for pure capitalism in healthcare. 

[Captainant 27405]

Just now, ChiTownDoc said:

As I said, that’s the exception.  Sorry it happened to your friend.  I can assure you I have a fuckload more experience than ‘one of my friend’ stories.  We are probably with thousands of plans and healthcare systems.  But really sad story.  Thanks for sharing.  It doesn’t give you equal footing in this conversation.  

Fair, and the personal anecdote crowding out actual data is definitely a fallacy we're all vulnerable to. Completely ignoring that fallacy, I'll give another datapoint though: in 2010 my dads Parkinson's progressed significantly and drove a huge amount of medical bills from tests and therapies recommended by his neurologist to better manage his disease. My sister at the same time, broke her back on the UT rowing team and we discovered some nerve damage in her back that required months of physical therapy. My family burned through about $60k in an eyeblink, which happened to be our college savings. And then they kept on racking up medical bills and costs, only my dad kept getting worse and worse options because my family didn't have enough money. Because you've gotta get your spinners on your rolls and the insurance company middlemen gotta get their bonuses. 

It was nothing we could have planned for. No preventative behavior to mitigate my parents financial reset and decade long freefall. 

The system isn't built to guarantee good care. It's built to create shareholder value and deliver profits. Just acknowledge that. 

[chainsaw 9836]

4 minutes ago, Sawbonz said:

Medicare and Medicaid fee schedules are set by law. There is no negotiation; take it or leave it. The system relies on the good heartedness of providers to take care of these patients although it costs the practice money to see them. That is not capitalism. And I’m not really sure where you are going with this anyway as no one on this thread is advocating for pure capitalism in healthcare. 

You just said you were discouraging people from even going into the field. I know the fees are set by law and not negotiated but I also know that nobody is forced to rely exclusively on them. The system that controls the whole field is capitalist, not Medicaid.

[ChiTownDoc 21097]

Yeah it’s not even close to pure capitalism.  That would be a whole other level of clusterfuck.  

[Sawbonz 27392]

2 hours ago, Bullneck said:

Interesting.  I've heard medical bills being sold to collection agencies who hound people (sometimes using illegal means) forever.

Now that the surprise medical billing act is law I would expect a lot of this to go away. I bet a lawyer could make a tidy sum with a boilerplate fuck off letter to the hospitals/providers 

 

also advice for patients: do not let these unpaid bills go to collections. Stay in communication w the facility. Offer to settle for what Medicare allows. Most will take that. If you are trying to get it to zero fuck you

[chainsaw 9836]

Just now, Sawbonz said:

Now that the surprise medical billing act is law I would expect a lot of this to go away. I bet a lawyer could make a tidy sum with a boilerplate fuck off letter to the hospitals/providers 

 

also advice for patients: do not let these unpaid bills go to collections. Stay in communication w the facility. Offer to settle for what Medicare allows. Most will take that. If you are trying to get it to zero fuck you

What even is "the facility" though? The kid gets a sharp pain and is brought to a freestanding ER (a whole other thread worth of fuckery with those) and for years you'll get questionable bills from people you've never heard of, have no relationship with, and no reason to believe the bill is even legit.

[ChiTownDoc 21097]

1 minute ago, Captainant said:

Fair, and the personal anecdote crowding out actual data is definitely a fallacy we're all vulnerable to. Completely ignoring that fallacy, I'll give another datapoint though: in 2010 my dads Parkinson's progressed significantly and drove a huge amount of medical bills from tests and therapies recommended by his neurologist to better manage his disease. My sister at the same time, broke her back on the UT rowing team and we discovered some nerve damage in her back that required months of physical therapy. My family burned through about $60k in an eyeblink, which happened to be our college savings. And then they kept on racking up medical bills and costs, only my dad kept getting worse and worse options because my family didn't have enough money. Because you've gotta get your spinners on your rolls and the insurance company middlemen gotta get their bonuses. 

It was nothing we could have planned for. No preventative behavior to mitigate my parents financial reset and decade long freefall. 

The system isn't built to guarantee good care. It's built to create shareholder value and deliver profits. Just acknowledge that. 

Nice bogeyman but I didn’t get any of my toys by screwing the system and we deny care to nobody over their payer or lack of.  
 

Also, the ‘my friend’ story I kicked this off with was a 55 yo middle class man in an EU country who died from a totally operable renal cell cancer.  Just sat there waiting.  I had the films reviewed here with a great radonc and all.  I’m sure the 50k collections goat rodeo is considerably less painful.  Maybe you disagree.  

[Biff Tannen 45491]

So anyway, if we have a negative birth rate, is the US going to collapse?  I can't imagine that being the case.

[Captainant 27405]

Side note: not sure how we ended up talking about capitalism vs communism, but something's gotta change in our American system. We can't keep treating human beings like they're just numbers on a balance sheet for MBA's to push around. Sometimes the best outcome isn't the most profitable. 

Our capitalistic system needs something besides pure profit as a motivation. 

[Sawbonz 27392]

3 minutes ago, Captainant said:

Fair, and the personal anecdote crowding out actual data is definitely a fallacy we're all vulnerable to. Completely ignoring that fallacy, I'll give another datapoint though: in 2010 my dads Parkinson's progressed significantly and drove a huge amount of medical bills from tests and therapies recommended by his neurologist to better manage his disease. My sister at the same time, broke her back on the UT rowing team and we discovered some nerve damage in her back that required months of physical therapy. My family burned through about $60k in an eyeblink, which happened to be our college savings. And then they kept on racking up medical bills and costs, only my dad kept getting worse and worse options because my family didn't have enough money. Because you've gotta get your spinners on your rolls and the insurance company middlemen gotta get their bonuses. 

It was nothing we could have planned for. No preventative behavior to mitigate my parents financial reset and decade long freefall. 

The system isn't built to guarantee good care. It's built to create shareholder value and deliver profits. Just acknowledge that. 

I’m sorry for your loss of your dad. Parkinson’s is an awful and unremitting, fatal disease. Not sure what kind of care would have changed his outcome as that is way out of my area. I’m dealing w Alzheimer’s in my mom and it’s terrible. My stepdad has significant medical issues including bad heart and moderate expressive aphasia and he refuses to stop being her primary caregiver. 

[chainsaw 9836]

1 minute ago, Captainant said:

Side note: not sure how we ended up talking about capitalism vs communism, but something's gotta change in our American system. We can't keep treating human beings like they're just numbers on a balance sheet for MBA's to push around. Sometimes the best outcome isn't the most profitable. 

Our capitalistic system needs something besides pure profit as a motivation. 

I said that capitalism outlived its usefulness. I didn't say "communism" is the solution, but I won't mechanically reject an idea just because it's adjacent to or has some historical connection with communism.

That discussion arose from a comment about whether the planet can even support continued population growth. I believe that it can, but only if we get serious about changing how we allocate resources and produce things.

[Sawbonz 27392]

3 minutes ago, chainsaw said:

What even is "the facility" though? The kid gets a sharp pain and is brought to a freestanding ER (a whole other thread worth of fuckery with those) and for years you'll get questionable bills from people you've never heard of, have no relationship with, and no reason to believe the bill is even legit.

Every bill you get make them document what care was given. Yeah it’s a pain. Less of a pain than dealing with some idiot at a collection agency. 

[chainsaw 9836]

4 minutes ago, Biff Tannen said:

So anyway, if we have a negative birth rate, is the US going to collapse?  I can't imagine that being the case.

No, it won't collapse. It's just that some people can't fathom an existence where the US isn't #1.

[chainsaw 9836]

1 minute ago, Sawbonz said:

Every bill you get make them document what care was given. Yeah it’s a pain. Less of a pain than dealing with some idiot at a collection agency. 

That's good advice under the current system. But it's not an excuse for keeping the current system. If it can be improved, it should be.

[Sawbonz 27392]

Just now, chainsaw said:

That's good advice under the current system. But it's not an excuse for keeping the current system. If it can be improved, it should be.

If you can find anyone here arguing nothing should change I’ll join you in arguing with them

[Covri 6231]

12 minutes ago, Biff Tannen said:

So anyway, if we have a negative birth rate, is the US going to collapse?  I can't imagine that being the case.

This is a healthcare thread, if you want to talk birth rates, take it to the Elon thread.

[Sawbonz 27392]

We have no attention span lol