Do you pay too much for your penis pump?

If you do, you’re in the same boat as Medicare:

Vacuum erection systems — commonly known as “penis pumps” — cost the Medicare program $172 million over a six-year period, roughly double the amount the average American consumer would have paid at the retail level, according to a report released Monday….

The reason for this overpayment is that Big Dick has Medicare paying a high flat rate for a fairly simple and easily substitutable piece of durable medical equipment.  So let’s  talk about a couple of different payment models.

The administratively simple model is a fee schedule model where Medicare or anyone else says that for item or service Z, they’ll pay X amount.  This model is simple to run but it places minimal pressure on providers to lower costs.  A low cost provider has minimal ability to get customers to flock to the low cost value.  A high cost provider whose costs are of just slightly below the fee schedule won’t be force to cut costs.

Reference pricing is a modification of the fee schedule methodology.  Medicare says it will pay X and if an individual wants a more expensive penis pump, they’ll get X from Medicare and pay the rest out their own pocket.  If the price is under X, the individual pays nothing and Medicare picks up the rest.  Setting X at an intermediate level that cuts off some of the more expensive providers should save money while also at least giving the illusion of choice and option space.

There is one more, market based system to get penis pumps at good prices.

The final way that Medicare can pay for fairly generic durable medical equipment is to write a fairly specific set of specifications and then put those specifications out for bid.  Bidding for some types of durable medical equipment has been going on since 2011  and unshockingly, it has saved money.

This works because Medicare is often the largest buyer of medical equipment in the country.  Standard economics would predict that a big buyer of easily substitutable products made or sold by numerous entities should be able to use its size to get a great price.  Unfortunately, competitive bidding is a fairly isolated and unusual strategy as Congress is in hoc to Big Med that is scared of actually competing.

42 replies
  1. 1
    Baud says:

    So let’s talk about a couple of different payment models

    Yes. I’m sure that’s what we’ll be discussing in this thread. Payment models.

  2. 2
    TR says:

    Payment models? Where’s the money shot?

  3. 3
    Big R says:

    There’s so many MORE tags that should be on this post beyond “wonkery.”

  4. 4
    Botsplainer says:

    I thought a penis pump was a separate 75 buck tip after a private lap dance.

  5. 5
    NotMax says:

    Nothing to add, really, as the post covers the long and the short of it.

  6. 6
    Ash Can says:

    I admire Richard’s nice, smooth segue from the discussion of dicks to the mention of a Congress that, if it actually gave a flying fuck about controlling government expenditures, would have long since required Medicare to bid on contracts.

  7. 7
    Deffrey Jahmer says:

    Where do you live, Botsplainer? Thanks to a generally crappy economy here in NC, a full-on HJ is a private dance +$30, tops. Most dancers will rub you off through the pants as a standard feature in the VIP room. Of course, some clubs are less of a jack shack than others.

  8. 8
    Baud says:

    Just a quick reminder that requiring insurance to cover birth control is totes immoral.

  9. 9
    Richard Mayhew says:

    @Baud: I am unaware of my audience and all internet traditions

  10. 10
    Soonergrunt says:

    Why cover penis pumps at all? The very idea is fucking stupid.

  11. 11
    Baud says:


    It’s socialized fucking.

  12. 12
    Botsplainer says:

    @Deffrey Jahmer:

    That was a rate at one of the better Key West gent’s clubs, as I understand.

  13. 13
    raven says:

    This is much more interesting than ANOTHER FUCKING POST about whatever the fuck her name is.

  14. 14
    Pamoya says:

    So he is asking the government to subsidize his sex life. What does that make him? It makes him a slut, right? It makes him a prostitute. He wants to be paid to have sex. He’s having so much sex he can’t afford to get an erection. He wants you and me and the taxpayers to pay him to have sex.

  15. 15
    Baud says:

    Pen!s pumps may be expensive, but balloon juice is always free.

  16. 16
  17. 17
    Ben Cisco says:

    @Big R: “Wang-ery”, for one.

  18. 18
    Big R says:

    @Ben Cisco: I was thinking “wankery,” but that works too.

  19. 19
    Big R says:

    @raven: @Sarah, Proud and Tall:Does anyone ever see raven and SPT in the same room at the same time? That is a rather suspicious exchange….

  20. 20

    @Big R:

    I can’t believe we don’t have a Wankery tag.

  21. 21
    Big R says:

    @Sarah, Proud and Tall: Despite the 2009 crackdown on tag creation, I feel like this one is justified. Go for it!

  22. 22

    @Big R:

    Only if you haven’t realised we are all DougJ.

    Cole gave up blogging about two years ago, and Doug seems to be bored with sock-puppeting him, which is why we got both Betty and this “Richard Mayhew” persona.

  23. 23
    Big R says:

    @Sarah, Proud and Tall: Wait, if YOU’RE DougJ, and I’M DougJ…then who’s flying this plane?

  24. 24

    @Big R:


    If I vanish, it was Cole what did it.

  25. 25
    Big R says:

    @Sarah, Proud and Tall: Cole won’t do anything to you; he’s too afraid you’ll tell everyone about the time on Pitcairn with the seven Polynesian girls and three Adelie penguins.

    DougJ, on the other hand, has no shame. He’ll announce his peccadillos from the rooftops. Of course, since his peccadillos include shouting on rooftops, this is sort of a twofer for him.

  26. 26
    Deffrey Jahmer says:


    Ah, that would explain it. $70 alone will get you a special massage in Los Angeles.

  27. 27
    SRW1 says:


    Catch 22! You can’t fuck stupid with a limp dick.

  28. 28
    Richard Mayhew says:

    @Sarah, Proud and Tall: Updated, just for you!

  29. 29
  30. 30
    MikeJ says:


    Just a quick reminder that requiring insurance to cover birth control is totes immoral.

    The (very stupid) justification that I’ve heard is that ED is an actual medical problem that requires and responds to treatment and that birth control is a way of preventing something natural from happening.

    I don’t begrudge anybody treatment for any medical condition. I think it would be shameful to deny somebody treatment just because we would rather giggle about it or refuse to talk about sex at all. Of course I also think that when a doctor prescribes birth control, insurance ought to pay for that too.

  31. 31
    Big R says:

    @MikeJ: The response is that pregnancy is nothing more than an opportunistic parasitic infection; birth control is preventative health care, and thus under ACA must be covered with no co-pay (oh, look; right result, stupid reasoning. The best we can hope for from Republicans these days, I think).

  32. 32
    Matt says:

    If Medicare buys the penis pump, does that mean we get to watch the fucking (by El Rushbo etc logic on contraception)?

    Wait, Medicare… Lemonparty… NEVER MIND.

  33. 33
    Cervantes says:

    Do you pay too much for your penis pump?

    It turns out I definitely paid too much for my goose denippler.

  34. 34
    Villago Delenda Est says:

    @Big R:

    It will be difficult for a man in Georgia and a woman in Australia to be in the same room.

    Just sayin’.

  35. 35
    Villago Delenda Est says:


    Of course I also think that when a doctor prescribes birth control, insurance ought to pay for that too.

    Of course, the doctor might very well be prescribing birth control pills for a medical condition, not for contraception, which was the case that Sandra Fluke was testifying about…and not herself, by the way.

    This did not stop certain parties from making even greater asses of themselves on the public airwaves, however, to savagely characterize Fluke as a working girl who wanted a government subsidy for her personal expression of sexuality. You know, sort of like using the public airwaves to bloviate about Fluke’s sexual activity in a totally fact free manner.

  36. 36
    currants says:

    @Pamoya: THIS.
    @MikeJ: Medical or mechanical? You know, hydraulics? Just curious.
    @Big R: Can we use the same definition and apply the same logic to … you know … abortion? Or … why do I think the problem is something to do with XX-COOTIES-GROSS?*

    * (where XX=female, of course)

  37. 37
    Villago Delenda Est says:


    Well, does the VA cover various medications for limp dick syndrome? Not that you deal with that on a daily basis, as an IT person, but you might glean some info as you are performing your IT duties.

    I know my doctor asked (once) if my plumbing was working properly, as if to be fishing for the opportunity to add to my already extensive list of medications.

  38. 38
    Austin Danger Powers says:

    That sort of thing ain’t my bag, baby.

  39. 39

    OK this might be the best comment thread ever. Not the subject matter but the fact that the spoofing and trolling has gone so meta we can’t find DougJ anymore. Where’s Waldo has got nothing on BJ.

  40. 40
    divF says:

    @The Ancient Randonneur: I know, I’ve been sitting in a cafe reading the thread and giggling to the point where the other lounge lizards here are starting to stare.

  41. 41
    slippytoad says:


    don’t begrudge anybody treatment for any medical condition.

    Au contraire, I vehemently begrudge these withered old Congresspricks their socialized off-jacking.

    I took care of my body, and I don’t feel like I should be subsidizing their artery-clogging, virility-sapping overindulgent ways.

  42. 42

    […] citizens; anyone sixty-two or older usually has Medicare.  (And just as an aside, why does Medicare spend $ 29 million a year to pay for penis pumps?  No, […]

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