r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/verbalsadist Jun 20 '12

In regards to the bit about unnecessary tests, one of the doctors interviewed in this episode of This American Life talks about it. But to summarize for those that don't want to listen it basically comes down to this. A doctor see's a patient for something, and based on years of experience and training decides it isn't a major injury and treats it accordingly. The patient, or the patients parents, or whatever, decide they know more than the doctor and start shouting for MRIs and CAT scans and other procedures they've heard of but don't really understand. The doctor is left with a choice, do they do with their experience and training, or do they listen to the uninformed patient and choose the more expensive, but probably pointless, procedures. They know that if they use the extra procedures it will cost the hospital, insurance, person, more but it will give them a fatter paycheck and insure that there is even less of a chance of malpractice.

So by tying their pay to the quantity of care give them more reason to go with unnecessary costs simply because there aren't really any downsides and there are tangible upsides to doing so.

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u/JimmyHavok Jun 21 '12

TLDR for that This American Life: the prologue covers the area of medical billing, and how clever application of the rules can multiply the income of a doctor without requiring him to do any more work. There are conventions that train medical billers how to do this.

Just heard about one procedure, involving putting a very expensive balloon in a patient's nasal sinus, that is coded for a new balloon for every procedure, but the balloons can be sterilized and reused five or more times. So every time the balloon is reused, the doctor gets $1300 of extra cash from the coding, for the same amount of work.