It's probably more like 6 or 7 and united Healthcare also takes a cut. To do my paperwork.
An operation takes place in a room.
This is a nurse with a gown on and a cart with a set of scalpels, some hand tools such as clamps, some suture material and sometimes a stapling device and staples. She also has a suctioning device.
The patient is placed on a bed and draped.
There is a surgeon. He has gown on. He will refer to an imaging display device.
There is an anesthesiologist. He has an anesthesia machine, a heart and breathing monitoring machine, some gas tanks and tubing, a CO2 absorption container and material, and a mask for the patient. He will also have a few syringes and a vial with an off-patent pre-induction drug. He will also have airway management inserts and off-patent drugs in case there is a problem.
Sometimes, there will be a heart bypass machine and a nurse to man it.
Sometimes, samples of tissue such as from lymph nodes which might have cancer cells will have to be sent to a pathologist for examination.
It might take about 15 manhours for these people to do their work on the patient, on average.
The patient might have worked 80,000 manhours.
Healthcare pricing is based on systemic violations of decades-old consumer protection laws which are normally applied in every other industry.
These include the Robinson-Patman act of 1935 and the Clayton Antitrust act of 1914, and the Sherman antitrust act of 1890.
We already have laws which forbid most of what the Healthcare industry routinely does in pricing. How about enforcing them?
For health care, bring on market force:
1. Break most hospitals into two highly competitive entities
2. Convert other hospitals into real estate leasing entities with competing surgical suites and nursing wings
3. Separate out drug coverage so hospital systems can run care coverage systems and cut out insurance company overhead and meddlers. Hospital system plans might charge an age-related fee if you lack a drug plan listed by the hospital system plan.
4. Create interstate drug plans that don’t have to cover every drug. To qualify for exchange listing and federal subsidies, they would have to most (~80% or more) in all important types (large volume recombinant, small volume recombinant, breakthroughs under patent, etc.). Group and exchange plans to offer vouchers at plan set amounts for out-of-formulary drugs. Plans without minimums (or vouchers) could be vended directly to individuals and families.
5. These plans would be all the doctors (and AI) prescribe for formulary drugs with co-pays equal to manufacturing cost
6. Have drug patents limited by government sourced product revenue and overall domestic government health care spending and not by time [so drug companies have an incentive to minimize government health care funding]
7. Require Kirchoff patent collapse to a single entity upon FDA marketing approval of a covered entity
8. reform medical education, breaking down medicine and dentistry into simpler chunks and start it in the first year of college
9. replace most primary care doctoring with AI
(human doctor would confirm AI diagnosis, orders for expensive tests[MRI, genetic], prescribe radiation imaging/treatment, and voucher/government co-pay drugs)
If that fellow in NY had not killed the United Health Care CEO someone else would. Just a matter of time.
My experience with that outfit has been minor compared to what some others may have faced but for two years now I have been arguing with them over getting our accounts straight. They have randomly applied two separate checks, one for my account and one for my wife’s, to each of the accounts and blame everyone but themselves. The state insurance board has been surprisingly helpful and United fears them but the company is completely screwed up. Just a first class mess.
Where would anyone start to reform the health care mess? Perhaps with the insurance by state, introduce competition, return to not for profit hospitals? Is there any model in the world that works at reasonable cost?
If I want to appeal my county property tax assessment, I have to pay the tax the county wants before the appeal is argued.
This is a possible reinsurance model PPACA replacement scheme:
US citizens and lawfully present persons of a US resident household shall be eligible for coverage as per the PPACA.
The federally subsidy eligible expenses of each eligible issued policy shall be:
1. 85% of Medicare Part A scope coverage provider payouts,
2. 80% of Medicare Part B scope coverage provider payouts, plus
3. 80% of prescription drug coverage provider payouts on a policy.
Uncle Sam shall pay a share of the federally subsidy eligible expenses of each eligible policy equal to 30%,
plus 1/6th of each policyholders’ household premium calculation percentage below 400% of FPL that is above 40%.
[The 30% is to mainly cover the costs of chronic condition people.]
A policyholders’ premium calculation percentage shall be the lesser of 100% or 25 times:
their statutorily expected household monthly income,
less claimed expenses [subject to insurer confirmation]
divided by 1/12th the annual FPL amount for the covered household size.
Extractable profit to not exceed:
1. 1% of the Medicare amount, plus $100, for each inpatient episode paid within 30 days of initial correct provider billing and within 60 days of initial provider billing,
2. 1% of the Medicare amount, plus $8, for each other provider bill paid to the contracted amount within 30 days of initial correct provider billing and within 60 days of initial provider billing,
3. $1 for each off-patent drug prescription paid for, $3 if for 90 days,
4. $5 for each patented drug prescription paid for within 30 days of the policy year, $15 if for 90 days, and
5. $20 for each recombinant drug provision paid for within 30 days of the policy year.
Administrative related and in-house care costs shall not exceed the extractable profit limit, any applicable reasonable state law limit, or any policy limit.
Insurers may, with reasonable 30-days online posted notice, raise premiums of a PPACA policy type to reasonably expect to reach the extractable profit level based on actual and reasonably forecast expenses during the calendar year, subject to a 5% monthly premium rise cap.