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Among the many changes that health care is facing in the next few years, the most important, and most stubborn to contain, is medical costs. Every faction of the medical establishment from hospitals, physicians, drug companies and medical equipment suppliers are in league to keep costs where they are - inflated and untouchable. The medical industry has two main allies in keeping their profits rolling in: the ignorance of the paying public about the true costs of medical care and our Congress that feeds off the millions that the medical industry pays it.

But now a simple mathematical change in the way co-payments are made might revolutionize this sordid picture.  Right now everyone - you and me - make our co-payments as an absolute dollar amount. Upon arriving at a doctor's office, we are asked for a co-payment amount - $15, $25, $30, $50 - whatever your plan calls for.  The dollar co-payment sheds no light as to the actual cost either paid directly to the doctor or what she finally receives through the labyrinth of your medical insurance plan. One simple mathematical change could uproot all of this.

The proposed change is that co-payments would be a percentage of the actual cost instead of a fixed dollar amount. Simple, but earth-shaking. A percentage co-pay would strip the cloak of invisibility off much of medical cost. If a patient were asked for a 10% co-payment of $30.00, the total amount of $300.00 would immediately became visible; $45.00 - a total of $450.00; $100 the $1,000 cost of an MRI, etc. Now, for the first time, medical consumers would know the cost of the medical services they are asked to pay. Now these consumers could make an informed judgment as to whether to accept offered medical services that fall in the gray areas of duplicative, not medically necessary or too costly.

Will percentage co-pays come about? Not if the aforementioned medical establishment has anything to say about it; and, unfortunately, they do. Complexity and obscurity of medical costs and payments are the best barriers that keep these costs and profits high and the simple math of a percentage calculation could do away with the cost smokescreen. Sometimes the fiercest battles are over the simplest of changes.    

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Comment Preferences

  •  Sometimes the total cost is not known (5+ / 0-)

    There is I think some merit to informing the consumers of medical treatments the true cost of those treatments.

    But, often, the extent of the needed treatments, and therefore the true costs are not known at the time the service is rendered.

    Let's say you go to your doctor because you have noticed a lump on your breast.  Should you pay for a breast cancer screening exam, or pay for a breast cancer screenign exam, mammogram, biopsy, and mastectomy?

    Only after your doctor has examined you, received your test results, and consulted with specialist experts, can your doctor definitively know what treatments are necessary.

    Sometimes those treatments change in mid-course.  If you need a mastectomy, you might be in the hospital post-op for 2 days, or if you are unlucky enough to have complications to the surgery, you could be in the hospital for weeks.

    In my opinion, a much better option would be to have a national healthcare program to eliminate the need for health insurance and copays altogether.

    "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

    by Hugh Jim Bissell on Mon Jun 17, 2013 at 11:58:25 AM PDT

    •  Your comment is valid for the upper end (0+ / 0-)

      of medical services. Think, instead, of the millions of office visits where cost is known; or, better still, the medical provider would have to determine cost in order to assess a percentage co-pay.

      •  No, Hugh is absolutely right. (1+ / 0-)
        Recommended by:
        JamieG from Md

        You go in for a cough. A cough could a cold or post-nasal-drip;  in other words, these cost little to treat. It could be bronchitis or pneumonia (and viral or bacterial?); could be GERD, could be asthma, sinus infection. Could be emphysema; could be cancer.

        So, which should your physician charge you for before you even walk in the door?

        © grover

        So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

        by grover on Mon Jun 17, 2013 at 06:50:10 PM PDT

        [ Parent ]

        •  I think Nospinicus is talking about co-pays for (0+ / 0-)

          procedures, not simple office visits or consultations.

          Sometimes truth is spoken from privilege and falsehood is spoken to power. Good intentions aren't enough.

          by ebohlman on Mon Jun 17, 2013 at 08:29:34 PM PDT

          [ Parent ]

          •  Right. But a "simple" office visit can (0+ / 0-)

            Lead to expensive tests or even an expensive hospitalization very quickly.

            © grover

            So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

            by grover on Mon Jun 17, 2013 at 08:37:31 PM PDT

            [ Parent ]

    •  Yes, I would think that patients would be (2+ / 0-)
      Recommended by:
      grover, JamieG from Md

      way more against this system than the health care providers.

  •  What is needed to "save" the medical world (3+ / 0-)
    Recommended by:
    FG, cynndara, wilderness voice

    is a shift away from reimbursements made on a fee for service basis to something more like a "fee for outcome" basis.

    •  We need to dump the model (1+ / 0-)
      Recommended by:
      Roadbed Guy

      of the Doctor as "independent professional".  Almost no doctor practices as an individual any more, and as members of a partnership, they have little more power to set business terms than a somewhat-privileged employee.  Nor should the "professional judgment" of doctors be kept religiously unchallenged given that we are long past the point where someone who graduated a decade ago is going to be entirely up on new developments outside of his/her specialty, if that.  Most doctors know that, and practice as members of a group with access to other specialties because of it.

      Doctors should not be treated as totally independent, unquestionable arbitors of our fates.  And they certainly shouldn't be running businesses or getting paid as businesses (most doctors are terrible businessmen anyway, which is why they JOIN businesses run by people who understand things like that).  Instead, we need a national Public Health Service on an employment/salary model.  Again, most doctors are already on a salary, not a free-form sole-proprietorship receipt of practice income.  That's the truth, as opposed to the Myth of the Independent Primary Physician.  That being the case, there's no good reason why that salary shouldn't come from a neutral party (the State) rather than a business which exists for the sole purpose of turning human misery into Profit.

      •  This is only partly correct IMHO (1+ / 0-)
        Recommended by:
        That's the truth, as opposed to the Myth of the Independent Primary Physician.
        Sure, they're not independent, and not primarily physicians (necessarily), but they're not fully on the salary model, either.

        As explained in this New Yorker article, too often physicians do see themselves as business persons rather than primarily health care providers, and have vested interests in fee-for-service facilities.  

        Of course, it would not be ethical to own such a place (say, MRI center) and send your own patients there, that would be a definite conflict of interest.  But you * can * send them over to your friend's center in the hopes that he or she will reciprocate . . . .

  •  The result would be that most Americans would (1+ / 0-)
    Recommended by:
    JamieG from Md

    not be able to afford heath care or would have to refuse test, treatments or medications that they need but could not afford.

    I wont argue that medical costs are inflated,  they are, but even without the inflated charges most Americans would still not be able to afford any kind of serious injury or illness.

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