[mike777]

new database shows the discrepancies in billing for the same procedure among the nation's hospitals. The Huffington Post has an article that shows the billing for the same procedures at two hospitals: one billed $99,690 while the other billed $7044. The difference between what is charged as standard (to those without health insurance) must be designed to maximize the write offs when the uninsured cannot pay. This practice has repercussions, though, that affect everyone

---


Economics tell us that completion is good. Offer the best product/service at the best price and you will sell more. But doctors try and sell us less and at a higher cost.

For some reason the customer, you and me, will not walk out the door saying this service is terrible, good bye. For some reason you and I don't walk out the door from the 99k hospital to the 7k hospital.

My guess is and it is only a guess there are govt regulations that mess up this process. In any event there must be some real reasons why customers don't go to the 7k hospital and go to the 99k hospital.

In your example an insurance company should put us on a private jet and private limo send us a check for 10K and still save money if they send us to the 7k hospital. Again I am guessing that there are some govt regulations here that account for these costs.

[barmar]

Winstonm, on 2013-May-13, 13:45, said:

the latter never sees a reason to alter his position.

And as long as there are enough members of Congress like that, we'll continue to be stuck.

And it worries me that we're seeing attrition of the more rational members -- a number of them (e.g. Barney Frank) have recently retired or announced that they're not going to run in the next election, citing frustration with the current system.

[barmar]

mike777, on 2013-May-14, 08:34, said:

In your example an insurance company should put us on a private jet and private limo send us a check for 10K and still save money if they send us to the 7k hospital. Again I am guessing that there are some govt regulations here that account for these costs.

If you're having a heart attack (I think that was the procedure with the 7K-90K discrepancy) you might not survive if you have to fly 4 hours to get to the cheaper hospital. When an ambulance arrives, do they ever give the patient a choice of which hospital to go to?

[barmar]

blackshoe, on 2013-May-13, 11:57, said:

It's not that economics is complicated, it's that economics is not well understood, even by economists.

And why is that? Because it's a complex system that is extremely unpredictable.

The basic problem is that economists delude themselves into thinking that it's comprehensible. Not only is it complicated by itself, but the act of analyzing it and publishing the results changes it. E.g. if you predict that the economy will go in a particular direction, or that a particular company is a good or bad investment, it changes the behavior of the public and investors. It's very difficult, maybe even impossible, to take this effect into account when making your predictions.

[blackshoe]

barmar, on 2013-May-14, 09:03, said:

If you're having a heart attack (I think that was the procedure with the 7K-90K discrepancy) you might not survive if you have to fly 4 hours to get to the cheaper hospital. When an ambulance arrives, do they ever give the patient a choice of which hospital to go to?

Around here they do.

If I don't have an appointment with my (VA) primary care physician, I can't get to see him. I can make an "emergency" appointment, at least sometimes, but it may be a day or two before I get in. If it's a "true emergency" or after VA clinic hours (8 AM - 4:30 PM, M-F), I'm told to go to the nearest emergency room.

Strong Memorial Hospital here is widely cited as one of the best hospitals in the area, if not the country, for many things. IMO, their emergency department sucks. Not because the staff are bad, but because everybody and his cousin goes there at the drop of a hat. It's always overcrowded. I don't go there unless I have to.

[kenberg]

blackshoe, on 2013-May-14, 09:34, said:

Strong Memorial Hospital here is widely cited as one of the best hospitals in the area, if not the country, for many things.

From what I have seen recently, every hospital in the country is in the top ten in the country. They have a plaque on the wall saying so.

[Winstonm]

blackshoe, on 2013-May-14, 09:34, said:

Around here they do.

If I don't have an appointment with my (VA) primary care physician, I can't get to see him. I can make an "emergency" appointment, at least sometimes, but it may be a day or two before I get in. If it's a "true emergency" or after VA clinic hours (8 AM - 4:30 PM, M-F), I'm told to go to the nearest emergency room.

Strong Memorial Hospital here is widely cited as one of the best hospitals in the area, if not the country, for many things. IMO, their emergency department sucks. Not because the staff are bad, but because everybody and his cousin goes there at the drop of a hat. It's always overcrowded. I don't go there unless I have to.

The most likely reason the ER is overcrowded is that it has to service the uninsured so that is where the uninsured go with all problems, emergency or not. ERs are full of kids with sore throats and babies with RSV - and the charges for those services are written off and that loss is passed on to the insured as higher costs for insurance coverage.

If everyone were guaranteed coverage, ERs would be left to deal with genuine emergencies, while sick kids and babies could go to the clinics and doctor's offices.

[blackshoe]

Winstonm, on 2013-May-14, 10:23, said:

If everyone were guaranteed coverage, ERs would be left to deal with genuine emergencies, while sick kids and babies could go to the clinics and doctor's offices.

This statement, while probably true, contains the implicit assumption that "coverage" is the only way to deal with the problem. I don't know if that's true, and I submit that neither does anyone else. At the least no one, afaik, is looking at any other possibilities.

[dwar0123]

blackshoe, on 2013-May-14, 16:12, said:

This statement, while probably true, contains the implicit assumption that "coverage" is the only way to deal with the problem. I don't know if that's true, and I submit that neither does anyone else. At the least no one, afaik, is looking at any other possibilities.

What other possibilities? Like refusing emergency medical care to the uninsured? How many insured people have to die while they establish whether or not the patient is insured before you think that requirement goes bye bye. Oh and once you accept the patient, you're liable for them.

[kenberg]

I'm somewhat new at the emergency room business, but I have learned that if a doctor calls the hospital and says that he has told a patient to go to the emergency room, you get served a lot faster. This makes sense for a couple of reasons: The people at the desk know that there is at least one person with medical credentials who thinks this is actually worthy of the name emergency, and it's just in their nature to accommodate doctors. It worked as follows: I called the doctor's office, they got the on-call doc, I described the symptoms, he said get yourself into the emergency room, and he called ahead. It makes a difference.

[Winstonm]

kenberg, on 2013-May-14, 17:23, said:

I'm somewhat new at the emergency room business, but I have learned that if a doctor calls the hospital and says that he has told a patient to go to the emergency room, you get served a lot faster. This makes sense for a couple of reasons: The people at the desk know that there is at least one person with medical credentials who thinks this is actually worthy of the name emergency, and it's just in their nature to accommodate doctors. It worked as follows: I called the doctor's office, they got the on-call doc, I described the symptoms, he said get yourself into the emergency room, and he called ahead. It makes a difference.

Something else that makes a difference is how much you donate to the hospital. I used to work at a hospital in Tulsa and can verify that the charge nurse would get the call that a VIP was on the way. Not only did the hospital administration believe these people should be treated first, but so did the people themselves.

That aside, though, you are right that a physician's call can help cut the red tape. Without that, you are left to be triaged.

[mike777]

barmar, on 2013-May-14, 09:08, said:

And why is that? Because it's a complex system that is extremely unpredictable.

The basic problem is that economists delude themselves into thinking that it's comprehensible. Not only is it complicated by itself, but the act of analyzing it and publishing the results changes it. E.g. if you predict that the economy will go in a particular direction, or that a particular company is a good or bad investment, it changes the behavior of the public and investors. It's very difficult, maybe even impossible, to take this effect into account when making your predictions.

barmar the issue cannot be it is extremely unpredictable....or it is a complex system, that cannot be the issue.


but you I agree with your main point....for some reason economists delude themselves...that is the problem with social sciences compared to say math.... you hit upon the point.

but they don't delude themselves because the problem is hard, something else is going on in education/ higher education.
perhaps college football is one example of the greater problem along with research for social sci?

Something basically is wrong with social science research compared to say math research( not that math is perfect...just less bad)

[mike777]

Winstonm, on 2013-May-14, 18:13, said:

Something else that makes a difference is how much you donate to the hospital. I used to work at a hospital in Tulsa and can verify that the charge nurse would get the call that a VIP was on the way. Not only did the hospital administration believe these people should be treated first, but so did the people themselves.

That aside, though, you are right that a physician's call can help cut the red tape. Without that, you are left to be triaged.

Winston I have no issue ..none if what you charge is true.....that is a tiny tiny issue...

lets focus on what the big picture is? If only we can agree what that is?

If the number one issue is treat vip like crap....I give up, even socialists treat vip number one.

If not why bother being a vip?

if you want to make being a vip illegal and go to prison ...ok....
If you want to make being superrich or superpowerful illegal....and go to prison ok...if not.....then you know....

my only point is let us improve millions and millions and let the few, very few, super rich be super rich.

--



2.5 billion live on less than 2 bucks a day...


there are only a few gals worth billions and billions.....let them enjoy....

call it inequality.

[hrothgar]

mike777, on 2013-May-16, 04:02, said:

barmar the issue cannot be it is extremely unpredictable....or it is a complex system, that cannot be the issue.

but you I agree with your main point....for some reason economists delude themselves...that is the problem with social sciences compared to say math.... you hit upon the point.

but they don't delude themselves because the problem is hard, something else is going on in education/ higher education.

Something basically is wrong with social science research compared to say math research( not that math is perfect...just less bad)

FWIW, most graduate level Economics coursework is highly mathematical. It resembles Physics much more than History or Political Science.
When I was doing my graduate work, I needed to take differential equations, advanced linear algebra, and topology.

Most of the proofs and the mathematical analysis are quite prosaic. Either your math is right, or its wrong.

Where economics gets complicated is the set of underlying assumptions that one uses to construct said analysis.
No one can agree on the basic assumptions, hence the long standing joke "If you laid out all the economists end-to-end, you still wouldn't reach a conclusion"

[mike777]

I stand by main point

something, I don't know what, is going wrong with social science research compared to say math research at higher univ education. I use college football as an example of a univ going insane....nuts... with what they focus on...

At my local univ UNC we are told the main guy put 50-60% of his time on football not the rest of unc.....nuts.....


Economics is a point but far from the only one.

for starters I point to a critic such as Ariel Rubinstein as one small point, one small critic.

I can make some guesses but I don't have hard proof.

[mike777]

barmar, on 2013-May-14, 09:03, said:

If you're having a heart attack (I think that was the procedure with the 7K-90K discrepancy) you might not survive if you have to fly 4 hours to get to the cheaper hospital. When an ambulance arrives, do they ever give the patient a choice of which hospital to go to?

sigh I thought some one would say this but miss the main point for some reason.....economics..

why do you not have the hospital build across the street? why do you not come up with a solution to your own question?
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my guess and only a guess is that govt laws and regulations stop you.

[hrothgar]

mike777, on 2013-May-16, 05:09, said:

sigh I thought some one would say this but miss the main point for some reason.....economics..

why do you not have the hospital build across the street? why do you not come up with a solution to your own question?
--------


my guess and only a guess is that govt laws and regulations stop you.

I'd assume that the relatively high fixed cost of building and operating a hospital, combined with a highly stochastic demand patterns is a more obvious issue...

[mike777]

I thought someone would say this but really 99k compared to 7k and govt issues not the problem?

I mean really?

I looked into this and stopped after so many govt issues..


guys are you really trying to build a hosp or a clinic across the street?
I kept finding govt stuff stopping me.

[helene_t]

hrothgar, on 2013-May-16, 04:31, said:

No one can agree on the basic assumptions, hence the long standing joke "If you laid out all the economists end-to-end, you still wouldn't reach a conclusion"

The textbook we used at GDBA (http://en.wikipedia....omics_(textbook)) raised the question "why economists disagree" in the introduction and came up with the great answer: "the market's demand for disagreement".