$42,000 Prosthetic Hand Outperformed By $50 3D Printed Hand

An anonymous reader writes "A man named Jose Delgado was so used to using a $42,000 myoelectric prosthetic hand for the last year that he didn't realize that there were other options out there. Although Delgado, born without a left hand, was able to obtain the hand via his insurance, he found that a 3D printed 'Cyborg Beast,' an open source hand which costs just $50 to print, actually was more comfortable and performed better than the device which costs 840 times as much money."

Comments

and also reading machines for the blind

[Anonymous Coward]

cutting down on the absurb prices for 'prosthetic' devices is great, but someone who is blind has to pay $1000-$2000 for a "Reading Machine" and that's not so great, especially since in the USA this is not covered by Medicare, howoever www.topocr.com has a $5.00 program that does the same job with a $60 scanner or a $95 document camera, I have to say that I'm a happy customer, I wish more people would develop low cost technology that provides an alternative to the big ticket items that "medical" companies charge, mainly to people who can't afford it.

Sunk Costs

[ObsessiveMathsFreak]

The additional $41,950 is allocated towards sunk costs including

• - Cosmetic designs of a hand like-prosthetic to prevent adults staring uncomfortably and children exclaiming "cool"!
• - Insurance/class action insurance for when the prosthetic ends up injuring/irritating one or more users or people, or things, or otherwise perishable or damageable entities the hand interacts with.
• - Robustness to last through more than, say, 10,000 cycles before snapping into brittle plastic shards.
• - Salaries and children's college funds for the scientists, designers, and MBAs running the prosthesis companies
• - Salaries and children's college funds for the academic and medical researchers involved in prosthetic studies, both mechanical, psychological, and sociological

Meanwhile, the 3D prosthetic hand has only the following sunk costs to cover.

• - ~$10,000 investment in quality 3D printer
• - The time taken find and to add the most saccharinly kitch music to 3D printing application videos on Youtube.

It's important to remember to keep the background details out of perspective... or in perspective, depending on whichever context you'd prefer to hock.

Re:Sunk Costs

[rolfwind]

Cosmetic designs of a hand like-prosthetic to prevent adults staring uncomfortably and children exclaiming "cool"!

Idk about you, but I'd think an obvious robot hand would be easier to deal with than a fake looking piece of plastic mimicking a human hand.

Re:Sunk Costs

[ColdWetDog]

- and since it is a commercial product, a couple of million dollars getting it approved by the FDA.

It all adds up.

Re:Sunk Costs

[im_thatoneguy]

Well, not only that but most people don't know how to operate a 3D printer, nor how to customize the hand to fit the individual. So while the $42,000 hand includes the professional services involved with fitting the device, the 3D printed one depends on a charitable donation from the 3D printing operator to do the work. It won't be much but it's all probably going to be significantly higher ($400-$1,000) for the human being to operate and configure the 3D model for the individual.

I bet there are only $100 worth of aluminum, gold, silicon and acrylic in the $42,000 hand too.

This drives me crazy when people don't include the costs of labor. It would be like someone getting a car donated to them and saying "Wow cars only cost $200 for a title and registration! Why do people pay thousands of dollars for a car!?" Because someone gave you one for free!

I work in film production. I have a $50k camera that I rent out. On most productions your total rental per day will be about $2,000 a day. Now you could say that you could shoot a TV commercial for "only $2,000 in rentals!" But that ignores the fact that cameras don't operate on their own, lights don't just place themselves, actors should be paid for their skills, assistant directors need to keep production on schedule, locations need to be paid for the rights to use their property etc. So yeah it "only costs $2,000" as long as you ignore the $20,000 per day in crew costs for a small production.

People who say a film only costs $20,000 to make are either productions that somehow shot and finished in 1 day or else they're saying that their crew's time was worth nothing.

If I spent $10,000 on a 3D printer. I couldn't just open the box and push the "Give me a 3D Prosthetic Hand" button. I would either need to spend a good week or so learning how to print ($100 an hour * 40 hours = $4,000) or else spend $1,000 on a professional to setup and configure the scene/hand for me specifically. /Rant.

Re:Sunk Costs

[Anonymous Coward]

I worked with a guy for years, though I only met with him every few weeks at most. Turns out he only had one arm the entire time I knew him, but it was a long time before I realized it, and I wasn't sure about that for quite a few meetings since his prosthetic was so good. Someone later just happened to mention that he'd lost it in a traffic accident years before.

Being initially inconspicuous might matter to some people.

If I lost a hand I'd definitely go for the robot look though.

Re:Sunk Costs

[JanneM]

Idk about you, but I'd think an obvious robot hand would be easier to deal with than a fake looking piece of plastic mimicking a human hand.

It's probably impossible to know until you are actually in the same situation. There have been highly functional, highly useful hand prosthesis long before robotics - the classical hook is just one example - but the vast majority of patients have always preferred a hand mimic, even when it is completely nonfunctional and even when the mimiry is far from perfect.

Not getting stared at, and fitting in, is critically important to people, in this case as in others. Should'nt be too surprising when you think about it in such terms.

Re:Sunk Costs

[CodeBuster]

To be fair, some of these costs would exist in any business. There are always capital equipment costs, employee costs, administration costs and in some cases research and development costs. However, you are on the right track with your criticism of artificially high medical device costs. Indeed, these high costs can be seen not just in prosthetic hands or limbs but also in more mundane devices such as hearing aids and prescription eyeglasses. In my estimation there are two main reasons for this:

First, the devices are sold through specialized middlemen who bill your insurance company which in turn bills you and perhaps your employer for premiums. This is the classic third party payer problem that exists throughout the healthcare industry here in the United States and is in no small part responsible for the high costs which are ultimately borne by the consumer in the form of higher premiums and higher out of pocket costs.

Second, and related to the first point, the market for FDA approved medical devices here in the United States is highly regulated and therefore high cost. There is a great deal of regulatory rigmarole and ceremony required to bring a product to market. This imposes costs of course, but it also results in delays while the product winds it's way through the circuitous approval processes. By the time something is approved for sale as a medical device it's not only expensive but often obsolete or at least several generations behind the state of the art technology.

Finally, it ought to be remembered that medical devices are now assessed an additional tax under Obamacare, on top of any previous expenses. It's hard to see how this will lower costs, especially for those who find themselves in need of a medical device. Although, I suppose that "reform" is in the eye, or the hand in this case, of the beholder.

Re:Sunk Costs

[The123king]

Not getting stared at, and fitting in, is critically important to people, in this case as in others. Should'nt be too surprising when you think about it in such terms.

Being that self-conscious about things that have happened or are out of your control is a waste of time, and that's coming from someone with a birth defect. If you're getting a prosthetic for extra freedom and usefulness, great, but getting a fake hand for the sake of a fake hand is just being vain IMHO.

Re:Sunk Costs

[itzdandy]

This is really the point. The $40K+ prosthetic is simply over engineered. It's a poor argument saying that we should support engineers, their families, their companies, etc so that they can charge a disabled person $40K when we could have a single developer make a much simpler product that can be produced at a local 3D fab shop or in the garage of an enterprising neighbor.

Clearly this is an early version, though fully functional. Improving aesthetics can certainly be an optional component. Today, a black or clear acrylic prosthetic would be of very little concern to many people and I only see that as becoming more of a non-issue.

The other interesting part of this is that someone in need of such a device could invest in the tech to customize and produce a device specific to their needs. maybe they have a palm, or less to work with. Customizing the device to suit them at their own pace with rapid prototyping changes their disability. The thriving makers movement can facilitate the sharing of schematics so you might find a near-ready model that you can alter to fit. maybe even spawn a boutique prosthetic shop in your town.

   

Re:Sunk Costs

[jxander]

There's also the concept of "Price the Market will bear," which gets convoluted in the mire of health insurance companies. No one really knows what the market will bear, cuz it's always just payed whatever price was asked.

$42,000 for a prosthetic hand? Sure, if that's what it costs.
$1000 for an MRI? OK, if you say so.
$500 per pill to treat my hypochondria? Seems reasonable... etc.

Right now, the market will bear a 42,000 hand. And these guys could probably sell their $50 version for 45,000 on the claims that it performs better and feels more comfortable. The real costs of medical stuff (operations, hardware, medication, etc) has long since been lost to the bureaucrats.

Re:Sunk Costs

[laird]

You're coming very much from the prospective of a wealthy American/European, where a $42K prosthetic is an option.

But if you're not covered by very good insurance, which is the case for the majority of humanity, an affordable 3D printed hand is much better than nothing.

And a free/open innovative community working on prosthetics can move much faster than the commercial options, and perhaps innovate past them the way home 3D printing exploded past the commercial 3D printing companies. The commercial guys were too concerned with the expensive/subtle issues, when what people may well care more about is being able to cheaply and easily solve their problem.

You're right that the $42K prosthetic isn't the same as the $50 one. A major difference, which you missed, is that it's myoelectric and active, while the $50 one is mechanical. It turns out that for this patient, the simple, mechanical solution worked better than the sophisticated, computerized one. So it's fundamentally a cheaper, simpler solution.

The rest of the costs pretty much come down to the traditional business model vs. FOSS. If you want to buy a product from a company that you can sue, with MBAs and lawyers and on-staff researchers, etc., you get to pay the big bucks for the product. If you don't have the money for that, or you prefer free/open source solutions for other reasons (such as the ability to modify the designs to suit your personal needs), you can go the Free Open Source Software route, and print your own.

Yes, this relies on volunteer labor to do the printing, assembly, fitting, etc. There are 600+ people registered at http://enablingthefuture.org/ (mainly in the Google+ group). That's the point - by empowering people with FOSS designs and documentation, they can help each other, at much lower cost than paying professionals with all of the overhead that you mention. And it turns out that many of the volunteers work professionally in the field - this is just a new way for them to apply their skills to help patients.

And I'll also point out that your comments reveal some misunderstandings of how rapidly 3D printing has progressed.

- It doesn't cost $10K for a quality 3D printer. You can get a fine 3D printer for $1K, or a cheap one for $300, and the most expensive home 3D printer is $3K. There are some great industrial printers, but it would be stupid to buy an industrial printer to print one thing - there are plenty of people and Maker spaces who already have 3D printers. See http://enablingthefuture.org/c... and register if you're interested. And of course there are service bureaus such as ShapeWays if you really want a high-end printed version.
- The materials aren't as fragile as you think. There are 100+ people happily using ABS prosthetics now, and we're finding that printing in Nylon is amazingly durable. You can hammer on Nylon, and just bounces back. Amazing stuff. Hospitals and medical researchers are using 3D printed Nylon now, so using it for prosthetics is pretty reasonable.
- If you can print a replacement for the raw cost of materials, that changes the economics. If you can print your own replacements for $1, it doesn't make sense to spend $millions in R&D, and spend vastly more for the prosthetic's materials, because the cost of avoiding breakage far outstrips the cost of the breakage.

All of the designs are published, and open source. So there's nothing being hidden in the video - you can download the models and inspect them to your heart's desire.

If you don't like the music that someone selected, feel free to make a better video!

Re:Sunk Costs

[PopeRatzo]

I had an uncle with a wooden leg and I thought it was a big deal until I found out my aunt had a cedar chest.

Re:Sunk Costs

[ruir]

This comments are rather naive. The prosthetic costs 40K+ because the system is designed to rip off insurance companies, and inflate the bill 3 or 5 times more when dealing with insurance claims. The same as with a car accident... someone hit my car a couple of years ago, signed a term of responsibility and neither did she not care to deal with me in human terms, nor she replied to my emails. So down the line, two months were gone, and by the time I had it being repaired, her insurance company received a bill of $4000 USD something, and told her the monthly payments would be going through the roof. She called me, and said, cant we solve it out of the system? I said no way lady, you did not deal with me during two months, and my car is already being repaired. The point is out of the system, the bill would have been probably between $400-$800 I suspect. The sad part of it, is at the end of the day we pay higher insurance costs because of this bullshit.

Re:Sunk Costs

[sjames]

So what you're saying is that the conventional prosthetic is made by a horribly inefficient company that should have been washed out by the market but the market failed (as is typical for anything vaguely medical).

The 3D printed prosthetic had to be designed as well and apparently it was designed better. It could probably be stronger and even cheaper if it was mass produced.

Re:Sunk Costs

[sjames]

It's more that it's poorly regulated than that it is highly regulated. The FDA has no concept of risk assessment. Medicine is highly regulated everywhere in the 1st world, but it is vastly more expensive in the U.S.

Re:Sunk Costs

[mwvdlee]

Mod parent "+1 attention whoring crybaby".

Re:Sunk Costs

[Hognoxious]

No, but he is imposing his values on others.

He might not care about appearances. That's good, it's how it should be.

But it isn't how it is - some people do care. Some of those people might be potential employers who wouldn't want a "wierdo" or a "flid" around because it might disturb colleagues and customers.

Re:Sunk Costs

[usuallylost]

In the video that is attached to the article the guy says that in addition to the 3D printed components there are "various bits of hardware, Velcro, padding etc". All of which requires some know how and some assembly. So unless somebody came out with very good instructions or perhaps a kit with all the additional parts I doubt the average person is going to make this at home.

The other thing that is not really touched on there is that the $42,000 hand hooks onto the entire forearm. It uses the muscles in the forearm to control the actuator. Where the 3D printed hand hooks over the stump of the guy's left hand and uses the muscles in his palm to control movement and to provide the actual strength. A lot of people with missing arms don't have the palm of their hands left to provide that strength and control. For those people the 42K version is going to continue to provide utility where as they wouldn't be able to use the $50 version at all. For this particular type of case the $50 outperforms the 42K version. If you took 500 people with various levels of amputation I suspect that the 42k version would help a lot more of them than the $50 version.

What is shows me is that there is a tendency in the prosthetic industry to try and go for a one size fits all solution. Where it is clear that for some patients you could use a less expensive solution. It might bare some research to see just how many people are being fitted with 42k prosthetic when much cheaper solutions might work better for them.

Re:Sunk Costs

[Hognoxious]

Benighted moron. Have you read the story here about batteries?

His mere presence will bring costs down by an order of magnitude. He can do an ERP implementation in three and a half minutes.

Shun the unbeliever! Shun! Shun!

A different beast

[Sarten-X]

I'm no expert in prothetics, but it seems the printed Cyborg Beast hand is a completely passive device, relying on wrist movements to control the fingers. On the other hand, the $42,000 device was a "myoelectric prosthetic device, which took signals from the muscle fibers in his forearm, translated those signal, and then used them to mechanically move the fingers of the prosthetic, which looks pretty close to an actual hand."

This guy prefers the less-realistic device. Good for him. A direct comparison is somewhat unreasonable, though.

Re:More money does not always buy better things.

[turbidostato]

"A $30 aeropress coffee maker is as good as a $5000 espresso machine"

Haven't tested a $5000 one so I can't say. I tested espresso machines at any bar at, say, Venetia, and I can attest that no, your $30 aeropress coffe maker is no challenge for them.

"A double edge safety shaver that uses 20 cent blades is far superior to any expensive disposable shaver system, even the ones with 5 blades."

I use them and I agree.

"A $150 Formica counter top fulfills all the duties of a $3000 granite counter top."

The $150 Formica counter top at my rented flat and my mother's 30-year-old granite one beg to differ.

"And yet we are constantly told by marketing and advertising that better equals more expensive."

Yes, marketing (publishing, to better say) is quite clever in using bad rationals to push sells.

Better equals more expensive and that's right more times than not. The point is that more expensive doesn't equate better (see? even you fall on bad rationale).

One word answer: Liability

[Theovon]

When you buy a medical prosthetic from a medical company, almost none of the sticker price covers materials or basic engineering. Most of the money is split between liability insurance and extra R&D and testing overhead to make damn sure that someone won’t misuse the device, thereby generating a law suit. In Law, products liability is a huge area; big companies have deep pockets and often lose in suits where the user of their product was clearly doing something really stupid. (Chain saw instructions: Do not use hands to stop chain!) The fact is, people are sue-happy, and that’s the primary reason why all medical devices cost so damn much.

If someone is selling 3D printed prosthetics, they are GOING to get sued, and they’ll get put out of business very quickly by some moron who found a way to hurt themselves in a heretofor never conceived of manner. It’s just inevitable.

If someone were to make open source designs avaiable for prosthetics so that people could print them themselves, you’d think that the user would be taking all the liabilty into their own hands right? Ha! When something goes wrong, the maker of the 3D printer will get sued. And no matter what kind of disclaimer they put on it, the maker of the 3D schematics will get sued too. All because people find amazing ways to hurt themselves and sue over it. Especially with medical devices.

Why do you think airline food is so damn expensive? When something goes wrong with a plane, everyone gets named in the suit. The airline, the airplane manufacturer, all subcontractors of said manufacturer, including the company that made the rivets, the supplyer of the airline food, the pilot, you name it.

Show me the books

[Anonymous Coward]

The additional $41,950 is allocated towards sunk costs including

• - Cosmetic designs of a hand like-prosthetic to prevent adults staring uncomfortably and children exclaiming "cool"!
• - Insurance/class action insurance for when the prosthetic ends up injuring/irritating one or more users or people, or things, or otherwise perishable or damageable entities the hand interacts with.
• - Robustness to last through more than, say, 10,000 cycles before snapping into brittle plastic shards.
• - Salaries and children's college funds for the scientists, designers, and MBAs running the prosthesis companies
• - Salaries and children's college funds for the academic and medical researchers involved in prosthetic studies, both mechanical, psychological, and sociological

When I see the actual books - not what the PR people say or what is reported to the SEC* - then I'll believe it.

The CEO class - actually they are MDs in the medical industry sometimes with a MBA on top of that - usually gets the spoils.

And the insurance on the lawsuits is exaggerated.

*They don't have to nor do they volunteer to report the most of the above costs. All you will see is overall insurance costs, R&D, and lump sums of ALL the salaries. To get an actual product cost (indirect and direct) is impossible outside of the company. So unless the parent happens to be the CFO or in accounting of one of these companies, the parent's post is speculation - at best. And let's keep in mind that ALL businesses cry about their costs, government regulation, and all those unwarranted lawsuits to justify their obscene profits; when the truth is they could make a fraction of their profits and still do quite well - as we can see with companies in the same business who make a very nice living in countries other than the US that have civilized medical costs and single payer systems.

I actually worked in a dental device company. The part was made for $5 out the door - including government shit and lawsuits/insurance, it ws then marked up to $25 - because we could; the distributor marked it up to about $100 - because they could; and the dentist charged the patient $200 - because he could on top of his labor.

A $5 hunk of metal cost us $200.

Rather than compare...

[Rick in China]

I see them as having different purposes. Rather than go into details about the hands and their obvious/not so obvious differences or the minutia of when which performs better and how to define PKI for those metrics, it can bes implified into: At least poorer people have options now, that is ALL that matters.

Re:obamacare says "no way"

[laird]

Several reasons:
1) Many people don't have insurance, or have insurance that doesn't cover prosthetics. 3D printing prosthetics is a huge enabler for people in the third world, for example. And even in the US, there are plenty of people that the insurance companies don't or won't cover.
2) The ability to make your own, and to customize it to your needs, is very powerful. If you watch the video, the patient was happier with his $50 printed prosthetic than a $40k prosthetic, because it worked better for him. In part this movement is driven by people's desire to make something better than the commercial options.

Re:More money does not always buy better things.

[jklovanc]

A $30 aeropress coffee maker is as good as a $5000 espresso machine.

Things aeropress can not do;
- Heat the water
- control temperature
- steam milk
- foam milk
- Make a shot in under ten seconds
- . grind the beans
- operate by pressing a button.
The $5000 espresso machine is generally used for commercial shops and is much more versatile that an aeropress. An aeropress is similar to a $5000 espresso machine in the same way a sewing needle is similar to an industrial sewing machine.

A $150 Formica counter top fulfills all the duties of a $3000 granite counter top.

Formica is not as resistant to burns/stains/scratches as granite and does not have the look of granite. Why not make all flooring thin vinyl. It covers the floor.

Just because two things have a similar function does not make them similar in value or price.

I make prosthetics for a living.

[joeshmoo]

I am a prosthetist, and I regularly fit and bill for these devices as a result. Sure it sounds great that this particular patient can get a hand made for $50, but it’s not a fair comparison and doesn’t necessarily apply for every amputee. Also, as several others have pointed out, that does not take into account the labor or other overhead costs. (Cost estimates that follow are just some ballpark figures)

First off, the patient has part of his hand, and has opposition capabilities at his wrist. If his amputation level was directly through the wrist, or higher, the 3D-printed hand would need a harness or some other element to provide the body power. He’s also lucky enough that he can get away without having an extensive socket to suspend the 3D printed hand on his arm as a result.

Based on the myoelectric prosthesis shown, the $42,000 cost is likely “Usual and Customary” cost. At a contracted rate with insurance on a device like this, you’re probably best case looking at about $16,000 actually being billed to the insurance company. Looks like a Sensorhand Speed (or similar) hand being used, which has a parts cost upwards of $4000 from the manufacturer. The electrodes, battery unit, and custom made socket probably cost an additional $3000 in parts. The billed amount to the insurance company includes the prosthetist’s evaluation, casting, manufacturing, fitting, and subsequent follow-up and adjustment appointments for 6 months.

All that said, the patient probably shouldn’t have been fit with the system shown; most of the benefits he’s stating (such as holding a box at work) are more related to him having a proper limb length with the 3D printed hand! The myoelectric prosthesis shown has thrown off the alignment of the hands for performing bimanual tasks, placing his prosthetic hand way further from his elbow than his sound side hand. He would probably benefit from an M-finger prosthesis which would probably have only run about $5,000 to the insurance company, even being custom made to match the patient. Probably $1500 in parts.

.... but if they said a $1500 prosthetic hand was outperformed by $50 3D printed hand, people wouldn’t get as hyped up.

Re:One word answer: Liability

[Anonymous Coward]

You have no idea what you're talking about. We're dealing with a medical device in this situation, not some open source piece of software that jerks off Linux penguins. You cannot simply release specifications for a medical device and think that because you made them free and said you're not liable that you won't get pounded into the ground by a lawyer who is much, much smarter than you. Grow up and face the real world some time.

The reason medical devices are expensive

[kheldan]

If it's any sort of 'medical device' then the FDA must approve it before allowing you to sell it in the U.S., and in order for it to be approved by them you must do testing the FDA mandates. The testing is complicated and very often expensive, and if your device can't pass the testing then you have to go back to the drawing board and fix whatever it is that causes it to fail the test. Additionally the FDA demands certain manufacturing standards. They can come in and inspect your production facilities, personnel, methods, procedures, tools used, etc. If they don't like the way the communal kitchen looks or whether the communal refrigerator is clean enough for them, or any number of other nit-picky things, they can prevent you from selling or even producing your device; they can shut your company down completely. Sometimes the cost of all the testing and jumping through the hoops the FDA requires you to jump through will cost more than your device costs to produce. The end result is the costs are all tacked on to the final price of the device being manufactured. The 3D-printed prosthetic obviously wasn't FDA approved and couldn't be mass-produced and sold without going through the same process that everyone else has to. Since 3D-printing is relatively new and there hasn't been much if any legislation to govern it's use, what will likely happen at some point in the future is that anyone offering the CAD/CAM files to produce something like this prosthetic hand on a 3D-printer will be jumped on by the FDA and required to do the requisite testing of the finished product or face legal action against them. Furthermore I wouldn't put it past the FDA to require only 'authorized' 3D-printers to produce such things. Of course if it's all open-source and people are building their own 3D printers then the FDA can more or less go fuck themselves, but there'll be a shitstorm over the whole subject, guaranteed.

Source of my information: Personal experience from working for a medical device manufacturer for 5 years.

Re:And the developer of the 3D printer is relying

[laird]

"steal the IP that others spent time and money designing, testing and getting approved"

The designs of the 3D printed prosthetics are substantially different from modern commercial prosthetics, because the manufacturing process is utterly different. And mechanical prosthetics have been around for a very, very long time. So there's no "stealing of IP". Really, do some research before accusing people of theft.

"people actually ignorant enough to believe that a part is going to magically design itself in a 3D printer"

So far what's happening is that people with design skills and a 3D printer are making designs to help themselves or others in their area. Then they share the results with people who can then adapt and print the files. So what's "magically" happening is that people are sharing their work freely, to everyone's benefit. Because they need the problem solved so they solved it, but they don't want to be in the prosthetics business so they gave the design away.

You know, like Free Open Source Software. Which has worked out pretty well so far.

Re:Not "the craw"...THE CRAW!

[PopeRatzo]

OK, I realize I may skew a little older than many Slashdot readers, so here. Consider this your Easter gift:

http://youtu.be/ftgAG3Vnif8

Re:Obamacare exists because...

[NoKaOi]

Obamacare exists because the poor can't be bothered to pay $90 for a doctors visit...losers that don't pay

Can't be bothered? If you have a medical issue that requires several $90 office visits, and the choice is between paying that or feeding your family (or possibly buying gas to get to your minimum wage job so you don't lose it), how is that "can't be bothered?" Oh, and then you call them losers. So which is it, they can afford to pay but can't be bothered, or they are losers who would rather sit on the sidewalk than get a job? It seems you only see those two options, which pretty much means you are completely unfamiliar, yet pass judgement on a part of our society that comprises a pretty significant portion of the US population.

Re:Obamacare exists because...

[oic0]

$90? lol. That IS what your insurance company pays them. A person paying cash however pays 200-300 at the door and is billed for the rest. Usually another 200-300. Last time I visited the doctor without insurance it cost me $500. Most people would only need major medical if doctors weren't a bunch of greedy pricks who charge insurance companies a fair rate and rape anyone who tries to pay in cash. If a doctor were on fire I would ask for his wallet before pissing on him.

Re:Obamacare exists because...

[ProfBooty]

What did you pay $500 for?

My inlaws are visiting from overseas so no insurance but:

$40 for a check up
$80 for x-rays
$20 for anti-biotics

All in cash.

Later we found out that we could have gotten it all for free via the county health department. I guess it depends on what you are getting treated for.

Re:Obamacare exists because...

[Bryan Ischo]

It would be more accurate to say that when the service is free, as it more or less is for poor people, then the service is used by those people without consideration for the cost of providing that service.

My wife is a doctor, and has worked in the Bronx and also in low income areas of San Jose. In the Bronx it was not uncommon for people to call an ambulance when they had a cold and wanted to see a doctor to get some cough medicine prescribed, because they didn't have to pay for the ambulance and it was a free ride to a free doctor's visit for a condition that doesn't need an ambulance or a doctor.

In San Jose, she sees tons of drunks and drug users who end up returning to the hospital over and over again because it's the easiest way to milk the system for some attention (I suppose drunks don't get much out of it, but drug users can often badger the system into providing some pills; when presented with a persistent patient with unverifiable claims of pain, after a while the doctors have to prescribe something just to get the person out of the way so that patients with real needs can be seen.

Making everyone pay a nominal amount for every visit is not possible because hospitals cannot refuse anyone, even if they can't pay. But forcing people to get insurance, so that they pay ahead of time, seems like the next best thing.

Also virtually nobody in the USA chooses between a $90 doctor's visit and feeding their family. The choice is usually between a $90 doctor's visit and a $90 cable or cell phone bill.

Re:Obamacare exists because...

[Anonymous Coward]

No, the problem is that you'll always hear from the losers more than the winners. My brother in law was finally convinced to buy health insurance on the exchange. Two months later ... he was in a terrible accident that would have bankrupt him had he not had insurance. Win for him, but you won't find him on the evening news.

Re:Obamacare exists because...

[Anonymous Coward]

Well it's not that simple and as an addict I know this very well and you obviously have no clue how hardcore withdrawals fucks with your mind. You'll do just about anything once they peak and you start feeling like the word is collapsing in on you followed by extreme mood swings, amplified senses, shitting yourself to death, extreme paranoia, body tremors, cold sweats, extreme nausea, depression, high blood pressure, erratic pulse, distorted time where minuets feel like hours, and that's just to name a few.

The shock from withdrawals from harsher narcotics can kill you and like it or not junkies need help at that point. Luckily for me there is a methadone clinic 1.5 hours away 3 "some people there drive 4 hours one way" hour round trip every day for a long time but now it's once a month. It's the only thing that has let me live a somewhat normal life.

For junkies very few options exist and if you don't believe me go out and buy a few Fentanyl patches and some Heroin and bang that shit for a few months then try stopping.

Re:Obamacare exists because...

[fremsley471]

In the Bronx it was not uncommon for people to call an ambulance when they had a cold and wanted to see a doctor to get some cough medicine prescribed

Could you define "not uncommon" please? Daily? Monthly? She saw this herself, or 'heard about it'? And the ambulance crews just waved them onboard, like wide-eyed innocents who could be duped that way? Yeah, ok. Did your wife enquire further, or just write it off as the feckless poor?

In San Jose, she sees tons of drunks and drug users... after a while the doctors have to prescribe something just to get the person out of the way so that patients with real needs can be seen.

In San Jose, they need to have their alcohol and drug addiction services massively improved. Addicts should know that they will be referred to specialists. Why isn't your wife tackling this, rather than just handing out the pills?

Also virtually nobody in the USA chooses between a $90 doctor's visit and feeding their family.

I'm guessing your circle of family and friends includes a wide number > 21 yrs old on minimum wage? Thanks for the perspective on what someone in the top 1% thinks of the bottom 10%.

Re:No escape from the tea party nomenklatura.

[Sique]

I got herpes already at birth. Pray tell me, o wise Anonymous Coward, how I could have possibly avoided it. (Herpes is a STD in just the same sense that the Common Cold is a STD. It can also be transmitted through sexual contact, but this is not their main infection vector.)

Re:Obamacare exists because...

[silanea]

Could you define "not uncommon" please? Daily? Monthly? She saw this herself, or 'heard about it'? And the ambulance crews just waved them onboard, like wide-eyed innocents who could be duped that way? [...]

Some input from a medic from Munich, southern Germany. Depending on which part of town you get assigned to you the number of frequent flyers varies considerably. From experience - no statistics to back that up, sorry - our gold card members are most frequent

1. in the poorest quarters where half the calls turn out to be drunks, junkies (who usually did not intend to see us) and socially isolated, but not necessarily homeless people looking for someone to talk to, and
2. in the older, still not so fully urbanized incorporated villages where elderly people of modest wealth abound who cannot properly care for themselves anymore, whose children have moved too far away to provide constant care but who are too proud to move into a dedicated care facility.

What keeps amazing me is that in spite of my - and other medics' - prediction after the banking crisis and the ensuing wave of unemployment the number of FFs type a seems to be more or less constant but type b has been climbing steadily. So this is only partly an issue of poverty. It has more to do with social isolation, with the increasing difficulty of maintaining a robust social network (not Facebook, the family-and-friends variety) that can catch people when they face difficult phases in their life so that they do not hit rock bottom.

Medical care has long transitioned into social care that along the way can also give you a pill or sew up a cut.

And as to whether the medics are duped: Someone wants to see a doctor, you take them to a doctor. That is what the law says. That is what our job description says. We try to avoid it, believe me. We sweet-talk, we bribe, we threaten. But if the patient is adamant, there is no way we are going to assume the legal risk of refusing transportation. The ER staff is not naive, they know their devoted customers. They will make them go through hell, put them through every annoying and time-consuming test they can think of. But guess what: Because of this practice with increasing regularity they actually find a legitimate medical issue that had gone undiagnosed by doctors who just saw the addict or the annoying elderly or the lonesome hypochondriac and treated that instead of the complaints and symptoms.

In medicine there is no easy answer, no magical solution.

Re:Obamacare exists because...

[nbauman]

In the Bronx it was not uncommon for people to call an ambulance when they had a cold and wanted to see a doctor to get some cough medicine prescribed

Could you define "not uncommon" please? Daily? Monthly? She saw this herself, or 'heard about it'? And the ambulance crews just waved them onboard, like wide-eyed innocents who could be duped that way? Yeah, ok. Did your wife enquire further, or just write it off as the feckless poor?

I am also skeptical of this story, which is at best second hand and at worst an urban legend.

Even assuming it is true, it would point to a transportation problem in the Bronx. I became more aware of this (in Manhattan) when I developed arthritis in my knees and once was unable to walk for a week. In order to get to the doctor, I had to take a cab, which cost me about $40 round trip. What if I didn't have $40? Sometimes there's no public transportation to the hospital even if you can walk. (BTW, according to Michael Moore's movie Sicko, the British hospitals reimburse patients for cab fare.)

Is the City paying thousands of dollars in ambulance fees that they could have avoided by paying $40 in taxi fares? Or $20 for car service?

Another reason I'm skeptical about this story is that I heard a talk by Lewis Goldfrank, director of the Bellevue Hospital Emergency Department, who said that because of budget cuts, they were forced to stop giving out a lot of drugs from the hospital pharmacy, including over-the-counter drugs. So are hospitals in the Bronx giving out OTC cough medicines that Bellevue is no longer giving out? Would the City save thousands of dollars in ambulance fees by giving people on Medicaid money to buy OTC drugs in their local drug store?

In San Jose, she sees tons of drunks and drug users... after a while the doctors have to prescribe something just to get the person out of the way so that patients with real needs can be seen.

In San Jose, they need to have their alcohol and drug addiction services massively improved. Addicts should know that they will be referred to specialists. Why isn't your wife tackling this, rather than just handing out the pills?

That's right. For a doctor to complain about drunks and drug users in the ED is like a sailor complaining about the ocean. Did she know when she went into medicine that a lot of people are sick because of drug and alcohol problems? Did they ever teach her how to deal with patients with drug and alcohol problems?

Goldfrank once asked one of his residents what cases were left, and the resident said, "Just some human garbage." Goldfrank told him, "Anybody who refers to patients as human garbage doesn't belong in this hospital."

It doesn't sound like your wife should be caring for this patient population. Perhaps she should go into a specialty with patients in her own social class, like cosmetic surgery. You can make more money running a hair transplant clinic than you can make by saving a diabetic woman's leg from amputation.

Also virtually nobody in the USA chooses between a $90 doctor's visit and feeding their family.

I'm guessing your circle of family and friends includes a wide number > 21 yrs old on minimum wage? Thanks for the perspective on what someone in the top 1% thinks of the bottom 10%.

I've talked to doctors who were fucking idiots. One doctor said that poor people could afford health insurance if they just spent the cost of a latte every day on health instead. When you're so out of touch with the realities of your patients' lives, it's malpractice. A lot of prescriptions don't get filled because the patient can't afford it.

A doctor wrote an essay in he New England Journal of Medicine about how her hospital was reprimanding doctors for violating the rules against giving patients their own personal money. She said one mother didn't have money for food for herself and her two children, so she gave the mother $20 (and told her it came from a "special fund" so the mother wouldn't be embarrassed).

Thanks for an informed comment

[Anonymous Coward]

Nice to see an informed post, though really what you have said for me only reinforce the subtext of the video, that the medical industry overcharges for products that often do not meet the needs of the patient but are in the practitioners interest. From what you have said it sounds like the patient was originally provided with a product that didn't meet their needs when other less expensive products would, and equally that the product provided was poorly fitted. It sounds like someone made alot of money out of this patient without the patient receiving real benefit for it.

Of course the patient may have originally asked for the more expensive type that didn't do what he wanted and would provide the highest commission for the doctor.

Re:Obamacare exists because...

[nbauman]

...forcing people to get insurance, so that they pay ahead of time, seems like the next best thing.

So tell me, now, how you're going to force people who are living on what they can dig out of the dumpsters behind markets because they don't have any money to buy food to buy health insurance?

Well, you're half right. People who are digging food out of dumpsters will usually be eligible for Medicaid, and making up to about 100% of the poverty level, will not have to pay anything. People who make up to 250% of the poverty level will get significant subsidies to buy Obamacare.

The problem is the people between poverty level and lower middle class. Obamacare pays to expand Medicaid to cover people making between 100% and 250% of the poverty level.

However -- because of the Supreme Court decision in the Obamacare case, the Medicaid expansion is voluntary for the states, and half the states (mostly Republican) refused to expand it. So in those states, poor people really are stuck. They do get kicked out of hospitals and get left to die of treatable conditions. http://www.texasobserver.org/a...

So you're half right. In Democratic states, people get Medicaid, and in Republican states, they do without.

Obamacare is a terrible health plan. Most people who understand the health care system wanted a single payer plan. They predicted that Obamacare would be expensive, lousy insurance. To pay for it, they squeeze most of the money from the lower class and middle class.

Re:Obamacare exists because...

[nbauman]

Obamacare exists because the poor can't be bothered to pay $90 for a doctors visit. Instead they rack up a $900 bill at the local hospital (because hospitals are required to see you, doctors aren't) and they never pay it.

this makes no sense. so, does the doctor's visit cost $90 or $900?

One of the most common problems is:

1. Patient has asthma.

2. Asthma gets worse.

3. Doctor prescribes drugs to control the asthma (~$60/month).

4. Patient can't afford $60/month for the controller medication, so he doesn't get it.

5. Patient gets an asthma attack, can't breathe.

6. Family calls an ambulance, patient goes to hospital, spends a night in the hospital breathing oxygen and maybe gets a steroid shot. Total cost: $3,000

Medicare saves: $720/year in asthma controller medication.

Medicare loses: $3,000 in one hospital visit.

I saw a printout of the admissions at Montifiore Hospital in the Bronx, and the most common one was an asthma attack. This is what happens to real people, in typical situations. No Ronald Reagan stories.

Re:obamacare says "no way"

[flyneye]

All in all, we should put money into 3D printing and regulate the medical industry like the criminals they are.
BUT, be prepared for the Koch bros. to try to stifle that like they did when the govt. presented solar/wind initiatives. Kochs got money in medicine too, surprise ,surprise.

Re:Obamacare exists because...

[gnoshi]

An in Australia, if you tried to reverse that you'd get lynched.
People here generally feel that everyone should have access to healthcare regardless of income.

Re:obamacare says "no way"

[operagost]

I feel that there's something wrong when a powerful lobby is fighting to make Hobby Lobby pay for abortions but doesn't mind people having to pay for their own prostheses.

Re:obamacare says "no way"

[scuzzlebutt]

Contraception != abortion. You're either making a joke I'm not getting or being deliberately obtuse. I hope it's the former.

Re:obamacare says "no way"

[RKThoadan]

> regulate the medical industry like the criminals they are

I got a bit of a chuckle out of this. The Medical industry is rather intensively regulated, and durable medical equipment (the category this stuff falls into) has among the most stringent requirements and an awful lot of red-tape to cut through.It's not necessarily a bad thing, but it does add a good chunk to the cost of these, and DME companies are generally doing very well.

Of course, all that regulation does is give you something your insurance might consider paying for, they probably can't legally pay for non-regulated equipment even if they want to. When you get things cheap enough that we can afford them without insurance, cool stuff can happen.

Re:obamacare says "no way"

[Anonymous Coward]

Out of curiosity, what part of the medical industry would you like more regulation in? I work for a company trying to assist the medicaid management groups in various states meet the state and federally mandated goals and measurements to continue serving the patients. As part of this, we need to contact the patients by phone. In addition to getting a script for this phone call approved by my own company's directors and legal eagles, we have to get it approved by the management group. This was all done in January, it's now almost the end of April, the state has yet to approve the script in question (and has no feedback for why it's not approved, or when we should expect approval, just that "it's pending"). These goals and measurements need to be hit by December. We're ready to go, the regulators are not. And this is just one of many bottle necks in the "medical industry" that is a result of over used and ineffective regulation.

Don't get me wrong, there are certainly reasons to have certain regulations in the medical industry. But we're long past the "helpful" regulation point.

captcha: inhuman
Pretty much the whole medical regulation industry.

Re:No escape from the tea party nomenklatura.

[Sique]

Oh, my mother also has the herpes since birth. It runs in the family, so to say.