edit: actually one of those people does verification (checking to see what insurance patients have, what is covered, and estimate what they will owe) and the other person just does authorization (getting the insurance company to approve the procedure)
When he was in a partnership with 4 other doctors, he started with a paper system. They had two receptionists, and three clerk/billers. I used to help him out with some tech stuff.
They implemented an EMR prior to the Medicare mandate, with an ROI driven by dropping 2.5 FTE. They ended up dropping the clerks and hiring IT expertise at a cost 50% higher than the clerks.
Medicare mandate came, and the EMR didn't meet requirements and had to be replaced. They joined a larger physician group, and paid for 0.2 IT FTE. But they had to hire two PAs and a NP to drive revenue and now have 6 clerical people. (+1 from paper)
Now they were acqui-hired by a sprawling medical network. Their cost center became a dumping ground for redundant hospital staff and they have 10 non-medical people (+5 from paper-based, independent practice). Now they run two EMRs and are transitioning to a third. They lost the ability to collect money at the counter, and now bill for every co-pay and lab. (My wife received a paper bill for $0.78 for a pregnancy test via postal mail)
In short, between bad policy, government encouragement of cartel behavior, and general stupid big company bullshit my doctor went from a progressive medical practice with talented doctors and medical staff to a bloated sales funnel for unnecessary specialist care over the course of about 15 years.
But the execution is a giant shit show. Trump abandoned it but I highly doubt anything will replace it.
If Trump doesn’t cause another financial disaster, there are chances the next President can make some headway to get US a sane healthcare system.
It’s so ripe for disruption. Amazon’s insane valuation I bet is also based on the fact that they are going after Healthcare. If they can bring Amazon level service and convinience we may turn the tables.
Personal preference but even though I don’t support making Bezos accumulate so much wealth, Amazon prime service is unbeatable. It’s just so darn convenient. I don’t see any close alternative.
Of course I said ok, fine...run it through insurance. That year I wasn't going to meet deductible so I had no incentive to go through insurance.
This still boggles my mind... I understand the insurance provider negotiates bulk rates, but we were paying up front, in cash, and were still quoted 8x the insurance price.
(My finger was infected. I needed a week of antibiotics. That was it.)
Final billing: 55k in total, but because of insurance I paid about 5k. Which still left me wondering... what did people without insurance do? How could they possibly pay that much money, if they couldn't even get insurance?
I discovered an interesting fact the other day about the US's massive % of GDP spent on health; they spend about the same % of public monies on health that other developed countries do, the extra % is private spending! [1]
Anecdata: I am in Australia and have private health insurance (notably: otherwise I'd be paying an extra tax levy and be worse of in $ terms), but all that has meant is that I can go to a private hospital instead of a public one for elective surgery. For ~$2k a year. A few years back I broke both my collarbone and my ankle on separate occasions. The ankle repair was entirely free. The collarbone was setting too slowly (opportunity cost: I needed to get back to work ASAP... normally they just put your arm in a sling and let it stitch naturally), so I opted to have a surgical repair, which was about $2k all up for the out-of-pockets.
[0]: https://www.thebalance.com/medical-bankruptcy-statistics-415... [1]: https://www.healthsystemtracker.org/chart-collection/health-...
Sometimes being dumped from a hospital in the middle of the night drugged at some random location.
Often times a small problem gets put off and becomes a much larger problem.
It becomes a burden on family and friends, sometimes leads to amputations and other surgeries such that otherwise could of been avoided with better care.
This a huge problem for a lot of people, especially if you add in the dental care that is needed and not obtained around the country.
ymmv
Even then it’s a pretty crazy amount for what is supposed to be a routine delivery. No epidural was administered.
I can see why young people aren’t having babies. You work like a dog to pay rent and barely make it. Having a kid puts those finances in jeopardy.
"oh need new tires? We can't tell you how much it costs till we actually install your tires"
I was a member of a "health cost sharing ministry" for about a year, while working for a startup that didn't offer insurance.
The idea was that I paid a monthly membership fee to the ministry, and in exchange they would cover my healthcare costs - minus a set amount, for which I was responsible directly. If I made the effort to negotiate a discount with the provider, that discount counted toward the part I was responsible for.
By inquiring about a cash discount and being able to provide a reasonable assurance that the bill would actually get paid in a timely manner, I never once paid out of pocket for a doctor's visit during that time.
They can give you a processing discount but it is negligible and only applies to services rendered at that time.
Also they have to pay the insurance handling clerk whether you pay cash or not. The marginal savings are small.
Ideally we'd be in a situation where your wife had time to do much of that stuff herself, so that she was cutting prices to attract patient load instead of paying 2 people to help increase the time available to serve patient load.
Growth of Physicians & Administrators 1970-2009 http://gomerblog.com/2015/12/healthcare-costs/
TL;DR: Our overhead is ridiculous.
Any one who has worked inside the beast knows single payer is the correct next step, followed by replacing fee-for-service (treating disease) with capitation (incentivizing wellness).
Not a big mystery. Just look around at what other jurisdictions are doing, copy what works.
1. Healthcare is a luxury that must be earned. Giving it away to people who don’t deserve it is categorically bad.
2. Jobs are important. Universal healthcare would mean fewer people working in the various health industry bureaucracies, which is categorically bad.
3. Business is important. Universal healthcare would kill or cripple health insurance business which is categorically bad.
I have friends working on single payer. I just attended a policy planning event last night. To your point, the outlook is pretty bleak.
I give money. I've also decided to also give time and labor.
Meanwhile, I've come up with a Plan B, a way to hack the current system to expand affordable coverage. Early feedback from my policy and industry friends has been very positive (which is a novel experience for me).
https://duckduckgo.com/?q=growth+of+physicians+and+administr...
Maybe this instance is more reputable?
https://fee.org/articles/the-chart-that-could-undo-the-us-he...
For future, I'll try to find the original cite.
I'm gonna be super chagrinned, embarrassed if I've been forwarding "fake news".
Good eye. Thank you.