Free hotel rooms, free stuff from Lowe’s and Amazon, and expensive healthcare

40% OFF ANYTHING AT LOWE’S: There are a couple of stackable Lowe’s deals you may be interested in:

• $10 off $50 via an Amex Twitter Sync promotion
• $10 off $50 via online coupons. There are other coupons as well: 10% off, $20 off $100, and $30 off $150. Go to Slickdeals for the links to all these.

FREE $5 FROM AMEX: Get a $5 credit from Amazon when you buy $45 of Amazon gift cards.

HOW TO GET FREE HOTEL ROOMS: Travel Is Free has a very helpful amalgamation of hotel Best Rate Guarantee resources.

OBAMACARE NUMBER-CRUNCHING: In John Mauldin’s weekly bulletin, he’s got a lot of interesting macro-type stuff on healthcare economics. For example:

A hospital system like the Cleveland Clinic currently bills about $18 billion for medical services and collect around $6 billion. (We do not know the exact numbers for the Clinic.) It costs such a system around $5.5 billion to provide all the services, and thus they are able to invest $500 million in plant, equipment maintenance, and new equipment at the Clinic. An institution like the Clinic gets this revenue by collecting from Medicare about $0.23 on the dollar billed, from Medicaid about $0.18 on the dollar billed, and about $0.38 on the dollar billed for the aggregate of commercially insured patients. We are sure this seems bizarre to someone from outside the US, and actually it does to us, too, but it is the way the system has evolved.

Very bizarre! I can’t think of any other industry outside of debt collection where you can only expect a third of what you’re owed.

Here’s a cost-cutting measure currently being put into place:

An article in Health Affairs indicates that in California the CALPERS system, the largest state-run health insurance provider, has gone to reference pricing in some areas – CALPERS gives employees $30,000 for a total hip or total knee replacement and lists the hospitals that charge less than that. Virtually all academic medical centers (those that provide care for the sickest, and those that train our future doctors, nurses, pharmacists, dieticians, etc.) fall into the high-cost group, and their share of the CALPERS patient population that has hip or knee replacements has gone from 54% to 35%, while the share for low-cost hospitals has climbed from 46% to 65%. (Only one high-priced group hospital in California converted to a low-cost group hospital in the past three years.)

The bottom line:

The prediction is these hospitals will be paid approximately 5% fewer total dollars next year and 25–35% fewer dollars in 2018, while treating a growing number of patients. Since more than 60% of their costs (in many institutes the figure is more than 80%) are for personnel, we either have to find ways to do things more efficiently, that is with fewer personnel to do the same amount of work (for example, as the Center for Integrative Medicine has done with the shared medical appointments for acupuncture or with the shared TrimLife Program); or to do things in new ways (to re-engineer care), as in the Lifestyle Medicine Program; or to do things with less-expensive personnel, for example, by substituting a medical assistant for a physician or nurse in some processes where a physician assistant is equally capable of doing those things.

There’s much, much more–please take a look if you’re at all interested in the current healthcare debate.