Why do healthcare costs vary so much by location?

El Paso and McAllen were compared, which was responsible. Same state, same insurance requirements.

I found the conclusion puzzling. Even though McAllen apparently has better facilities, doesn't Medicare pay the same amount for the same services, across the board? I can't help wondering what is missing in this picture? Are there more people accessing the medical care from surrounding areas in McAllen than El Paso? Is that why there is more money flowing in, or are the McAllen people going more often and getting more medical work done? Just throwing that out for discussion...

Another interesting article. This paragraph particularly struck me:

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

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This idea is anathema to the free market proportions, smacking of socialism. Many will argue that it destroys incentive, because doctors get paid the same, no matter how good or bad their care. That it seems to work will not dissuade these people from opposing anything similar, so I don't see how it will ever be implemented as a widespread model.

I also didn't see any discussion of health care cost comparisons tied to the cost of living in different areas. For example, I bounce back and forth between Salt Lake City and San Francisco, and I've had identical procedures done over the years in both places. The cost of an angiogram for example, is almost double in SF than it is in Salt Lake -- and the quality of care is no less in Salt Lake than in SF -- in fact, I'd say it's better.

Then again, the cost of an apartment in SF is two to three times what it is in Salt Lake.

And then there's the question of doctor skill. I had several expensive procedures done in SF, trying to find the answer to my medical woes. The answer turned out to be simple (And in fact, I finally self diagnosed and turned out to be correct. The doctor said, and this is a quote, "Hmm. I should have thought of that."

Not that she is a bad doctor, by any means. Everything done was logical and made perfect sense, and some of it was necessary to rule things out, or as a result of abnormal lab tests. But had she been a little more clever, or experienced, perhaps, it would have saved a lot of time and money.

Anybody got a link to a discussion of the specific policies are being debated under the label of health care reform? Other than that there is a debate and everyone's really worked up about it I haven't seen much coverage.

ColoradoGuy said:

Most of the screaming, as near as I can tell, regards the public option. Insurance companies, who claim (along with most Republicans) the government can't do anything right, are apparently concerned that a public insurance plan will be so efficient and low-cost that it will drive them out of the marketplace. I see a disconnect here.

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Yes, I've been having trouble figuring out how that argument makes any sense myself. If the government health plan is going to be so efficient that the private health insurers can't compete with it, let's launch it now, and drive the parasites out of business. That's an argument FOR the plan, not against it, in my opinion.

Not to sidetrack the single payer discussion, but here's a criticism of one element in the bill as it stands (according to a link I can't find): people can opt out of the requirement to carry health insurance for religious reasons, and do so without penalty, even if they're later determined to have been pretty much cheating. Massachusetts has a penalty for taking that option, if you later seek healthcare. It's meant to be available, historically, to Mennonites and the Amish.

Thanks for both those links -- informative and thought provoking.

My fear at present is that with all the compromises and competing interests, not to mention outright hostility to the whole idea, the only health care bill that can get passed will end up being a cumbersome, patchwork, muddled mess that will be only marginally better than no reform at all.

The most important change, the public option, may never make it into the final bill.

The other two important aspects, imo, are preventing insurance companies from refusing insurance for people with pre existing conditions and (with a tip of the hat to robeiae) some sort of cap on malpractice liabilities. I don't see either one of those getting in the final bill either.

preventing insurance companies from refusing insurance for people with pre existing conditions

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I'm pretty sure that is in the bill, rugcat. I was looking for it a couple months ago when reading something or other, and was very glad to see it in there.

Synonym said:

doesn't Medicare pay the same amount for the same services, across the board?...

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No, they have geographic regions where the price paid for the same service will vary. It is dependent upon the physical location of where the bills are generated, not where service was provided. So if you call your Dr's office about a bill and they tell you to call a long distance number for questions about bills, they probably have a billing office in a better paid region. There was talk of closing that little loophole a few years ago when I retired. I don't know if it ever got fixed.

Since at least 2001, when I got involved in DME, the equipment fees were based on the state in which the patient received the bill, not the state the bill was mailed from.

Don said:

Since at least 2001, when I got involved in DME, the equipment fees were based on the state in which the patient received the bill, not the state the bill was mailed from.

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Why am I not surprised that durable medical equipment reimbusement might be the opposite of physician payment by medicare? Do you work with medicaid or medicare or both? Now you have me confused. I may be thinking of medicaid. They used the same charge codes.

I was speaking of both medicare and medicaid, as far as DME goes. I don't know about physician billing, which is why I specified DME. I'm surprised it would be different for the two services, however.

Greens fees and club membership vary greatly in cost from place to place.

caw