The Grumpy Troll

Ramblings of a grumpy troll.

Medicine future

As we end up with more and more devices being able to be constructed by personal manufacturing and it becomes more routine, it will be interesting to see the effect upon the medical analysis industry.

A family member had a soft tissue injury to the knee; before the insurance company would pay for the MRI, they required an X-Ray, despite X-Rays not showing soft tissue injuries. It's bad enough that money and time is wasted on this, no matter who pays. It's more galling on the day that you receive the Explanation Of Benefits notification from the insurer, letting you know that you're out $200 in costs for the X-Ray and paying someone to read the X-Ray, because the deductible hasn't been met yet.

But while angry thoughts of "fraud!" are whirring around in my head, I look at the ridiculously inflated "submitted charges" column and see how much trouble we'd be in without the insurance having negotiated a lower rate.

While it's good to have free markets, free to negotiate deals of their own, there's something especially pernicious about a system where the insurers can push up the price more than threefold for the class of people "not our customers" and nobody else has the clout to do something about it. After all, the hospitals and staff are still doing Very Nicely Thank-You at the much lower amount the insurers pay.

Every time I look at how broken the US medical system is, compared with either of the two other systems I've lived under, I get depressed. Unfortunately, so few people here have lived under other systems that the insurers get away with the lie that the USA has the best medical healthcare in the world. Perhaps it does, for less than 1% of the people needing healthcare. Everyone else is stuck with doctors who don't have to follow basic hygiene rules such as washing their hands, because they're too important, so the USA has one of the worst hospital infection rates around, and a ruinously expensive system which is still managing to make Britain's NHS seem like a paragon of prompt efficiency.

And this is on a PPO, not the far more affordable HMO, where the options are more restricted and the service even worse, in our experience.

Fortunately, the history of technological development shows that changes most significantly affect those areas with the most entrenched waste and established cliques; one day, that may make those of us in the computer industry obsolescent, but I just hope that it first manages to democratise basic health care so that I can afford care once that happens.


Do bear in mind that the non-insurance price is set that high largely because the insurance companies have negotiated a low price for themselves.

Abolishing contingency fees would go a long way to help the situation. The "tort reform" movement is, alas, mostly funded by companies that want to get away with manslaughter; but requiring people to commit something of importance to them when starting a lawsuit, rather than just being able to fire them off whenever they feel offended, would go a long way to counteract the culture of fear among people who provide services for money. (It's not the cost of malpractice insurance - which has stayed fairly constant of late - as much as the feeling that if you don't do all the possible tests someone's likely to sue later, and defending yourself takes time even if it's paid for.)
Categories: USA health-care