[Winstonm]

As is normally the case with complex human activities, there are many ways to look at costs. Here is an article that helps explain all sides of the Mayo-led regional costs in Minnesota.

Quote

What makes care at Mayo more expensive?

....Mayo looks at the overall cost of treating a disease, not just the fees for individual tests or treatments, she said. "The integrated care, we believe, gets to solutions, diagnosis, a lot faster. So if you look at the speed to diagnosis, it would be faster and that would save money. But that's very hard to prove in a fee-for-service world."

[kenberg]

I very much like the article Winston cites.

The article quotes a Minnesotan trying to cope:

"I still feel very discouraged," she said. "I hope that either I get a better understanding and learn that maybe some of my concerns about it are wrong. Or they add more options."

and

"Minnesota Department of Commerce officials say they're aware choice and costs may be a problem for some in Rochester and hope to change that in the future."

I wish them luck.

And the explanation from mayo sounds very credible to me:

"We're not a community-based hospital. This is an academic medical center that does research, education and top-of-the pyramid care for the sickest of the sick," Harrington said. "The cost is naturally higher."

I get a picture of a highly competent organization doing very good work. We want to encourage such activity.

[Winstonm]

I read another article concerning Mayo costs and it pointed out that the costs figures the Dartmouth study used to show Mayo has low costs is based on Medicare figures - but when individual healthcare insurance companies list Mayo, it is one of the higher cost for physician services and not "in network" for many of those insurance companies.

Even then, that doesn't make them high cost or low cost - all it means is the data are difficult to interpret.

Here is that article.

Quote

None of this necessarily means that the Mayo Clinic is a high-cost health care system in Minnesota. I can think of at least four reasons why Mayo might still be a low- or average-cost provider.

First, Mayo may charge lower prices for hospital services. The Minnesota Community Measurement data represent only the average negotiated price for a sample of physician services. Hospital services represent a larger share of the health spending pie, and Mayo may offer lower hospital pricing. According to the Minnesota Hospital Association’s MinnesotaHospitalPriceCheck.org website, Mayo Clinic’s St. Mary’s Hospital tends to report lower hospital charges than similarly sized hospitals in Minnesota. But, this is the list price—the price on your bill that no one pays—and not the price it negotiates with health plans.

[PassedOut]

kenberg, on 2013-November-27, 08:13, said:

"We're not a community-based hospital. This is an academic medical center that does research, education and top-of-the pyramid care for the sickest of the sick," Harrington said. "The cost is naturally higher."

I get a picture of a highly competent organization doing very good work. We want to encourage such activity.

For run-of-the-mill medical issues, we use our providers here in Upper Michigan. For more serious issues, we go to Mayo. The system shouldn't penalize folk who live in Rochester because of that...

[kenberg]

PassedOut, on 2013-November-27, 08:38, said:

For run-of-the-mill medical issues, we use our providers here in Upper Michigan. For more serious issues, we go to Mayo. The system shouldn't penalize folk who live in Rochester because of that...

Right, and I hope that they find a way to manage it all. If I get a substantial case of poison ivy, I call my doc and a physician's assistant takes a look and prescribes a lotion. For the issues of the last year and a half, I am very pleased to be seeing folks at Johns Hopkins. Common sense suggests these distinctions. It's always a trick to get uniform regualtions to reflect common sense. It probably is partly my Minnesota roots showing up, but the article from Minnesota Public Radio that Winson links to suggests that they are giving it their best shot there. At the least, they seem to grasp the problem.

Back in the early sixties I was a grad student at the Univ of Minn with a wife going to the Minneapolis School of Art and with a young child. At that time there was something called the well-child clinic where you could take the kid for routine childhood stuff, subsidized by the county and provided at little cost. As I recall, you qualified for this by going in and telling them that your circumstances were such that you would appreciate getting it. This approach seemed to work well. As Mr. Porter tells us, "Times have changed..." We need rules, no doubt we do, but rules have a mind of their own.

[Winstonm]

If we could simply all get on the same page - find a way to provide the best healthcare coverage to all citizens at the lowest cost - we might have a chance to find an answer. I fear this can never happen unless we all decide to stop selling pet agendas and look for answers, regardless of where those answers lead.

[kenberg]

It's tough getting the family on the same page just for Thanksgiving. Becky, who enjoys simplicity possibly even more than I do, prefers Halloween as a holiday. But Happy bird day to all, of course.

[kenberg]

This being December 1, I guess we should at least pause to look at what has been accomplished. I think the best answer is that we don't really know, but it sounds incomplete. A link to a Post article that mostly just gives out what the government is claiming:
http://www.washingto...src=al_national

We see:

Quote

As a result of the improvements: the average system response time is under 1 second; the error rate is "consistently well below 1 percent"; the online system is stable — not crashing — more than 90 percent of the time; as many as 50,000 shoppers can use the site at the same time, or up to 800,000 visits a day.

OK, so if these 800,00 users hit the site and it works as claimed, fewer than 8.000 will experience errors. Well, it's something.

We hear from somene who gave it a try:

Quote

Even on Saturday, some shoppers who tried enrolling hours after a key upgrade was supposed to have been completed, said they were unable to complete the process.

"I only made it half way through the second section," said Liz Gallops, an insurance broker in Winston-Salem, N.C., who has tried several times to see what kind of options are available for herself, husband and daughter. "I entered my dependents but the system continued to ask me who my dependents were and would only let me add new, not claim the ones I had already entered."

The article finishes with

Quote

Dec. 23 is the deadline to sign up for coverage effective Jan. 1. In anticipation of high volume in the next three weeks, administration officials said they have set up a system to help consumers if they can't immediately get access to the site during times of peak demand. Shoppers the site cannot accommodate will be placed in an online queue. They can ask to be e-mailed when HealthCare.gov can handle more visitors.

This is the administration speaking, touting their success! I suppose they learned something by the earlier embarrassment of rolling something out as working when it was not at all working.


There are websites that I use, and websites that I avoid. I am very pleased that as a medicare participant I have no obligation to use this one. Sometimes, with patience and maybe a little cleverness, I can cope with a badly designed website. But I do this only if I have to. Given any choice at all, I expect that many people will avoid this website. Not ideology, just good sense.

[PassedOut]

kenberg, on 2013-December-01, 08:56, said:

OK, so if these 800,00 users hit the site and it works as claimed, fewer than 8,000 will experience errors. Well, it's something.

Not what I would call acceptable...

[ArtK78]

PassedOut, on 2013-December-01, 12:31, said:

Not what I would call acceptable...

It is what is called progress.

Besides, if the 8000 who had errors try again, the odds are very much in favor of their having a successful experience.

Other websites have problems, too. Yesterday, I was playing online poker on my laptop. I was at a bar in Buena, New Jersey (pronounced BYOO-NAH, not BOO-AYE-NAH). I was online with the Borgata website (NJ now has online poker). You have to be physically in the State of New Jersey to play. The website did not allow me to play, stating that I was not in the State of New Jersey. I will admit that Buena, NJ, really isn't much of a place. But whatever faults it may have, being outside of the State of New Jersey is not one of them (I know, make your own New Jersey jokes).

So, the Borgata website's program for determining the location of the player is not functioning well. I have heard that others have not been able to play on the website due to this flaw.

But of course it has only been a little more than a week that the website has been functioning. Give it time. I will give it time. Besides, it does allow me to play from home (most of the time).

Same thing for the US Government healthcare website. It is getting better. Give it time.

[kenberg]

I can give it all the time in the world, since I am not required to use it. I think that those who are required to do so might be concerned. Simply put, if I have to carry out a financial transaction on-line, i want to have confidence in the site. At its current stage, i cannot imagine anyone having this needed level of confidence. I think of myself as sort of middle of the road in terms of online transactions. I do it, but I am cautions. Having to use this one would scare the hell out of me.

Anyway, we shall see how it all goes. I oncew flew on a plane in another country that had been banned for safety reasons in the U.S.. I did it, but I was very glad when it landed. That's the way I see this website.

[Winstonm]

kenberg, on 2013-December-01, 21:15, said:

I can give it all the time in the world, since I am not required to use it. I think that those who are required to do so might be concerned. Simply put, if I have to carry out a financial transaction on-line, i want to have confidence in the site. At its current stage, i cannot imagine anyone having this needed level of confidence. I think of myself as sort of middle of the road in terms of online transactions. I do it, but I am cautions. Having to use this one would scare the hell out of me.

Anyway, we shall see how it all goes. I oncew flew on a plane in another country that had been banned for safety reasons in the U.S.. I did it, but I was very glad when it landed. That's the way I see this website.

There is nothing frightening about the website. Paying online is an option for convenience, not a mandate. In my own case, the insurance company I selected from the website mailed me a bill - I went online at their website and paid it. I am all set for 1-1-2014.

The biggest problem I had (back in early October) was in establishing an account. Once that glitch was fixed, the site was pretty easy to use until I got to the part about seeing and picking a plan - then I cannot say if the site had trouble or I simply had trouble figuring out how to navigate the website. Once I figured that out, it was simple and worked fine.

It really isn't a big deal. Now that it is working I doubt if anyone is in jeopardy of penalty for not signing on due to website issues - after all, hasn't the mandate been pushed back until the end of March? If the site can take care of 800,000 per day as advertised, then everyone who wants to find insurance via that site should be able to find it - not to mention that with the website working better, the pressure is off the phone sites so those should be easier and quicker to access as well.

[kenberg]

It's probably right to say that what could have been done has been done. We will now hear from Doris Day: Que sera, sera.

[Cthulhu D]

PassedOut, on 2013-November-23, 20:09, said:

You are wrong.

Mayo charges are comparable to those of other hospitals, most of them very inferior to Mayo. There are not many "leading hospitals" around the US, and the goal is (or should be) to get good quality healthcare to everyone. A key factor in Mayo's success is that Mayo is very well managed -- a fact that anyone who has used their services can attest -- and those management techniques can be applied generally.

Yes, I have made an error, for which I am sorry. I had the comparison the wrong way around. The Los Angeles' Cedars-Sinai Medical Center is the one that charges twice as much for the same quality of care as the Mayo clinic. Whoops.

Vampyr, on 2013-November-23, 19:10, said:

On what basis do they charge higher prices? Maybe this is something that needs sorting along the path to a single-payer system. I think that Obama-Care is an improvement on the staus quo, but the varied charges are not conducive to an everyone-covered system.

Here, if your condition is serious, you will be sent to a hospital that has a specialist unit. Otherwise you will go to another, more convenient, hospital. It seems to work.

You cannot get boob-jobs on the NHS, unless you can demonstrate that the size (or lack thereof) of your bust is causing you psychological distress (well, yes, it could be physical distress if they are too large.) The same applies, I think, to sex-change operations.

The UK system quite sensibly says the cost we will pay for procedure Y to quality standards Z is X and if you want to charge more than that you can get nicked.

(It's actually a really complicated schedule of graduated costs that reflect the complexity of individual cases, but hey)

[kenberg]

A side note to Cthulhu: The fact that you got Mayo mixed up with Cedars-Sinai does not surprise me nearly as much as the fact that you know of the existence of either. I grew up in Minnesota and everyone there knows of the Mayo Clinic. But as far as I know I never heard of Cedars-Sinai until it came up in this thread. I cannot name a single hospital in Australia. Ok, I have never been to Australia. But I have been to Paris and to London, and if I had gotten into an accident while I was there I hope someone would have known where to take me because I cannot name a hospital in either of those cities either. When Reagan was shot he was taken to George Washington, I remember that because my younger daughter was born there, but I can't recall where they took Kennedy.

Anyway, I am stunned that you know of the existence of either hospital, never mind that you got them crossed.

Back to health care, here and elsewhere. It was once simple, it is now complex. Someone earlier in the thread, maybe you, observed that it is much more difficult to effectively modify a complex existing system than it is to start from scratch. No doubt this is so.

There is another problem, and it occurs not only in health care. While I, and I think many people, hope for good fortune for everyone, we are most interested in good fortune for ourselves. Comparing average performance in two systems only takes us so far since I inevitably ask whether, in a proposed revision of our system, my own health care will be better or worse. I am fine with paying some extra taxes or higher premiums so that others might benefit, i am not ok with having my own options reduced. This goes to why there was such a reaction to it not being quite true that "If you like the plan that you have, you can keep it. Period". People do not entirely trust the government here. I would be surprised if it were different in Australia.

[Winstonm]

kenberg, on 2013-December-04, 07:46, said:

I am fine with paying some extra taxes or higher premiums so that others might benefit, i am not ok with having my own options reduced. This goes to why there was such a reaction to it not being quite true that "If you like the plan that you have, you can keep it. Period". People do not entirely trust the government here. I would be surprised if it were different in Australia.

I think this is a most reasonable approach. What I do not understand is the idea that wealth is not to be shared among the less fortunate. I only yesterday read a quote from, I believe, the ceo of Goldman Sachs who said that the U.S. is good at creating wealth but poor at distributing it. One would think it is not too difficult to grasp that $100 transferred from savers and distributed to 10 spenders increases the velocity of the money, boosts GDP, and thus creates jobs - yet the argument continues after 40 some years that it is the saving that creates jobs.

[PassedOut]

Cthulhu D, on 2013-December-03, 23:55, said:

Yes, I have made an error, for which I am sorry. I had the comparison the wrong way around. The Los Angeles' Cedars-Sinai Medical Center is the one that charges twice as much for the same quality of care as the Mayo clinic. Whoops.

The UK system quite sensibly says the cost we will pay for procedure Y to quality standards Z is X and if you want to charge more than that you can get nicked.

(It's actually a really complicated schedule of graduated costs that reflect the complexity of individual cases, but hey)

Ah. Thanks for the explanation. Now I have to confess that I'm not sure what "you can get nicked" means.

One reason that Mayo's numbers are so good is that Mayo specifically refuses to subject dying patients to extreme and expensive (and ultimately useless) treatments.

[kenberg]

Winstonm, on 2013-December-04, 09:03, said:

I think this is a most reasonable approach. What I do not understand is the idea that wealth is not to be shared among the less fortunate. I only yesterday read a quote from, I believe, the ceo of Goldman Sachs who said that the U.S. is good at creating wealth but poor at distributing it. One would think it is not too difficult to grasp that $100 transferred from savers and distributed to 10 spenders increases the velocity of the money, boosts GDP, and thus creates jobs - yet the argument continues after 40 some years that it is the saving that creates jobs.

And besides all this velocity stuff, it actually helps people. I have never wanted to give everything I have to the needy and live in a tent, but I think that most people are willing to give a helping hand. I think the problem of creating dependency is real, it's not just a fake issue created by Republicans, but it should not be an excuse for doing nothing.

[PassedOut]

kenberg, on 2013-December-04, 07:46, said:

But I have been to Paris and to London, and if I had gotten into an accident while I was there I hope someone would have known where to take me because I cannot name a hospital in either of those cities either.

We like to travel, and so are interested in medical care abroad also. One of our family members required medical care in Paris and was quite impressed.

Here are a couple of pieces by others that convey the essence of what cousin Alicia told us: Travelogue Paris: Rendezvous at the American Hospital

Quote

My point is, the French have one of the best health systems in the world and even if I had walked into a public hospital, I would have been fine. But the American Hospital is excellent- so good and efficient that I was seen too within 45 minutes of my arrival.

The Saga of Paying My Paris Hospital Bill - Finally!

Quote

Some of you may recall my December thread entitled “Back from Paris with a Broken Arm”. Two Parisian hospitals took very good care of me. At the first hospital, Hotel Dieu, I was x-rayed and casted. They sent me to another hospital for an orthopedic consultation, to confirm that surgery was not indicated. All that they required to register me for treatment was my American drivers license, and I was told that the bills would be sent to my home.

About six weeks later the orthopedic consultation bill arrived. Total charge: 22 Euros. A week later Hotel Dieu’s bill arrived – 62 Euros. So – total French cost for my mishap is approximately $130! I can only begin to imagine what it would cost a French tourist in America for injuries similar to those that I incurred!

[Winstonm]

kenberg, on 2013-December-04, 09:37, said:

And besides all this velocity stuff, it actually helps people. I have never wanted to give everything I have to the needy and live in a tent, but I think that most people are willing to give a helping hand. I think the problem of creating dependency is real, it's not just a fake issue created by Republicans, but it should not be an excuse for doing nothing.

I am certainly not in favor of total socialism nor do I believe the premises of communism - but I can look at the data and see that when the US had higher tax brackets and less regressive taxation (payroll taxes) that GDP was higher and unemployment was lower - over decades. I really don't think that revising the tax codes so that the upper 5% pay a little more in taxes will cause much of a dependency class.