Last post was apparently too vague. So here's a concise alternative:

1. Does Healthcare In the US Cost too Much?

2. If so what can be done about it?

Does Healthcare In the US Cost too Much?
Very much so. The cost of a simple doctor's visit can be upwards of $130. Last week I had blood work done. I haven't received the bill yet, but I assume it will be near $1,000 (as it was last time).

If so what can be done about it?
Tort reform should be the first course of action. When a mother can sue a doctor for a necessary break in her infants collar bone, there is a distinct problem with the system.

This will undoubtedly reduce the cost of malpractice insurance. Many doctor's, OBGYNs in particular, are being put out of business by the high cost of malpractice insurance (-Pennsylvania Example-). The scarity of these doctors increases the demand for their services, which puts a higher price on their time. A low supply to demand ratio almost invariably leads to higher prices.

Following that, 'administrative costs' should be cut. I am not generally a proponent of government involvement, however the extra costs added to simple items ($4 for a single tylenol, for example. Or $100 to cover the paperwork for a blood draw) need to be regulated by the government as healthcare is a necessary aspect of everyone's life.

I'm curious to understand what happens when you're a low earner - do you face the choice of death, unresolved serious medical issues or bankruptcy? - a devils alternative.



Something's very wrong there.

I've also been concerned by the high costs of pharmaceuticals in the US, and the limited free market preventing access to drugs in Canada.

An interesting point I've seen s been made is that employer's payments towards health insurance distort the actual cost of healthcare so that it is less visible to consumers, resulting in the market bearing abnormally high costs or profit margins.

1. Does Healthcare In the US Cost too Much?

Yes. If you stay in a hospital, the cost of just doing that overnight is in the thousand dollar range. The food isn't very good and there's no mini bar, plus you're being exposed to more disease germs than in a top notch luxury hotel, or anywhere else for that matter.

I once used a blood thinner for thrombosis treatment. It cost a lot of money, but I had a copay deal back then, so five bucks a pop. Then I lost that deal, and eventually found the nutritional stuff to keep thrombosis away, plus vipera buris (a homeopathic) that works a lot better and costs a lot less than the prescription snake oil.

Oh, I also tried out an MD who also did homeopathic. He didn't have a clue, sold me some antibios, and charged $75 for just 10 minutes of time.

What a racket. Seventy five smackers for nothing.

2. If so what can be done about it?

Return healthcare to nonprofit status. The overhead of administration (fat corporate officer salaries and bonuses) in a for-profit model gets passed on down to the patient. The pressure to make profit raises the costs across the board.

I'm doubtful that tort reform is the answer or the primary cause of the problem. The reason I'm doubtful is that this is the standard drum beat, and therefore has a high possibility of being propaganda. I've seen the stories too, but know what? Doctors are still doing their things. The healthcare facilities are big, shiny, expensive places. I'll bet the money's still being made even if patients win law suits.

Healthcare and the illegal drug situation have similiarities. When in need, a patient is in a way addicted to the treatment (MUST HAVE IT!), so there's little chance to say no. The drug addict of course must have the fix and so pays the price. In both situations, high profits motivate the providers. Take the high profit motivation away, and the situations will change. Healthcare will become more affordable and drug dealers will sell used cars, or maybe viagra.

So go ahead and do tort reform. Watch as nothing changes.

1. Does Healthcare In the US Cost too Much?

That is an understatement. Even with health insurance, most Americans are only one major illness away from bankruptcy; and now, the Congress has enacted so-called "reform" legislation to further remove even that protection from catastrophic medical expense.

2. If so what can be done about it?

If our elected representatives are unwilling to make the same healthcare available to the public that they have voted for themselves, then they should at least provide some means for putting medical insurance coverage within the reach of working people. One way would be to provide a dollar-for-dollar tax credit for health insurance premiums instead of just a personal deduction from income.

Why the Congress has failed to act on this issue of national concern is inexplicable and inexcusable.

The money is still being made (as always at the expense of the patient). However, the doctor crisis is not propoganda.

The price of delivering my first child (in 2002) was a little over $2,000. The same doctor, at the same hospital (with fewer complications) 2 years later yieled a $5,000 bill.

A quick glance at your television during day time programming will tell you why. 'Call the law offices of...if you or your child were injured during labor or delivery.' 'Were you the victim of the negligence of a hospital or doctor?' Malpractice insurance is meant for people who have been the victim of gross negligence - such as the woman in the late 90s who had the wrong breast removed. Yet, I was told I had a malpractice case for the 'pain and suffering' I experienced at the hands of the nurses during my first delivery - needless to say, there was no gross malpractice, just a few nurses who didn't read the signs right.

The health care facilities are required by law to be 'big and shiny'. For a time, this was the central cause of a debate over abortion clinic laws in several states (AL, AK, AZ, AR, CT, FL, GA, HI, ID, IL, IN, KY, LA, MA, MI, MN, MS, MO, NV, NJ, NY, NC, ND, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, WI) as the clinics are now required to meet the same standards as amubulatory surgical center. In most states, this means meeting certain architectual criteria - high vaulted ceilings, double wide hallways. Being 'big and shiny.'

When you suggested 'non-profit' status were you referencing the doctors (who can go for days without sleeps or seeing their family) or the hospitals?

You go to a state hospital. You say you can't pay and the government pays for you.

Also, there are federal laws that prevent people from being pushed into bankruptcy by medical bills. Those are the first charges to be wiped by a judge.


The high cost of pharmeceuticals would be a non-issue if the government would subsidise the pharmeceutical companies with the same vigor they do failing airlines.

Employer funded health care lets the doctors/hospitals charge more as the insurance company picks up the tab. However, they don't charge less to the uninsured patient - they simply point them to the Department of Health and Human Services to sign up for State aid.

Swiss Universal Healthcare

Everybody's got it, It's cheaper than ours, and as good or better.

Private insurers compete for individuals
Individuals pay for insurance
State gives a hand if individual is too poor to afford insurance, but individual must still make economic choice.

More important than tort reform is patent reform. Tort laws allow individuals to hold corporations accountable for malfeasance. Patents allow corporations to charge what they want for their medications, machines, and procedures.

Which one causes higher prices?

Altari,

Funny, the TV proof around here has to do with auto accident victims getting settlements from insurance companies. Sometimes work accidents. No mention of labor, delivery, doctors or hospitals. What was that lawyer's name who gave you the advice to sue for malpractice? Or was it someone who isn't a lawyer?



Right, and all that takes money. The money is being made. These facilities remind me of the big shiny insurance company buildings. I guess you are arguing that it is the government's fault that the buildings cost so much, having building codes. That must be why healthcare isn't affordable -- building codes.

High vaulted ceilings are necessary under code? That one is new. I was aware of wide hallways, but those don't cost much more to construct than narrow hallways. It's like empty space, you know, between two walls, a floor and a ceiling.

I don't know of any codes that require granite facings, marble walls or the use of large glass exteriors. I suppose a general look that goes with the community could be in place.

The city-owned hospital in Colorado Springs is big, dull and plain. It is also a non-profit organization. Gets the job done though.



Nonprofit status is for organizations. That sector could use some redesign -- or rather, closing of the loopholes, but the bottom line is that the profit motivation needs to be taken out of healthcare. In other words, get rid of healthcare corporations. Get healthcare off the stock market. Stop paying healthcare corporate officers so dang much.

I know that ER nurses go days without sleep or seeing family too. I'm not sure what you are arguing here. I don't think the corporate officers have this problem -- maybe some jet lag.

I live in Michigan and I've never heard of a "state Hospital" here. We have state and federal programs that provide medical coverage to the poor/uninsured but the problem there is finding doctors that accept the coverage and even with doctors that DO accept the coverage, many are not accepting new patients. I have also heard of patients being turned away at the ER after being asked if they have insurance and answering "NO". Yes a hospital will treat the uninsured if they're wheeled in on a gurney with a critical illness or injury but how many end up IN that condition to begin with for lack of coverage in the first place?

Example: An uninsured person (the working poor who have no coverage and make too much to qualify for state/fed aid) with a nasty cough doesn't go to a doctor because a doctor visit costs 150.00 dollars JUST to walk in the door (which begs the question, WHY is it a doctor can make 150.00 dollars for spending 10 minutes with a patient and that fee is MINUS any tests). At any rate this person with the nasty cough can't afford an office call, let alone a prescription so he/she doesn't go. The Upper Respitory infection progresses to pneumonia, this person passes out at work and has to be rushed to the hospital. How does THIS benefit anyone? We're ending up paying for an ambulance run, treatment in the ER AND tests, a hospital stay etc... All for something that had this person been able to seek medical attention in the first place, would NEVER have progressed into a much more expensive hospital stay. THIS is one of the things that I believe seriously drives up costs, far more than lawsuits. States that have instituted tort reform have NOT seen a drop in healthcare costs.

As to your second point that Federal Laws prevents people from being driven into bankrupcy due to medical bills...If that law worked why do we have 50 percent of the reasons cited for bankrupcy filings being attributed to medical bills? Now we have this new bankrupcy bill that Bush is slated to sign that will stripe away the clean slate on medical bills for many bankrupcy filers. They will have to pay back a portion of those bills over the span of 5 years after filing for bankrupcy...So we're allowing this problem to grow by punishing people for the having the audacity to become ill.

The first thing I notice anytime this topic is discussed is nobody really has a complete understanding of why health care costs are so high. Everyone has their theory of choice: malpractice insurance, pharmaceutical companies, greedy health care corporations, compensation for non-paying public care... et cetera. I've heard people complain both of a shortage of nurses, and seeing nurses just standing around doing nothing. I certainly don't pretend to understand the entire issue, and even friends of mine who work in the health care field don't have a full grasp of it.

My instinct in big, complex issues like this is to first, admit that all these factors that people list probably play a role. Second, try to look a the problem from as far outside as possible. To this end, think of the health care system as a black box. A certain amount of money is paid in (through insurance, state programs, etc.), a certain amount of health care is provided, and a certain amount of profit flows out towards shareholders, employees, lawyers, etc. A question arises then, not are we paying too much, but are we getting what we're paying for? Then, how efficient is the system? I've heard said that our health care system, in terms of care provided, is one of the best in the world. Could it be that it is so expensive because we are paying for the very best technology, the longest and most technical care? (Although, of course, it is not evenly distributed.) It may be that we are paying a lot, because in the end, we get a lot... even if it only goes to a very few. A problem also cited is because of the current structure, most care provided is of the extreme, expensive kind, because people avoid going to the doctor with small problems. This is inside the black box, but represents an efficiency problem.

Also to be examined is how much money is flowing out as wages and profit. Are doctors over or under-paid? Are companies receiving too much profit relative to other businesses? (Then we need to ask, what systemic problems cause this... is it because of monoploy effects?) Is too much money being pulled out to lawyers? (I've read that, while appreciable to some fields, to the whole system malpractice insurance costs only represent a small fraction of total health care costs.)

The challenge in reading and learning about this issue is that every commentator seems to have their axe to grind, and it is rare to find a wholistic analysis of the system. I challenge those who argue it to try to wrap their mind around all causes and effects. When examining solutions, then, we have to think about how all these problems must be resolved together. To do this we need to come up with some common goals:

1) Routine health care should be available/provided to everyone at low cost (to the gov't or consumer, same diff... it's taxed if not paid directly.) This can be done through a government health care, one-size fits all system, through laws that permit/force companies to provide baseline care without obligated expensive care, a mandatory insurance law, etc. We need to figure out how to make routine care affordable, and not assume that a government managed and funded system is the only way to do this.

2) Some means of reducing the cost of prescription drugs, through increased competition, gov't price controls, or regulatory changes. Overall, the systemic cause for high prices in the US needs to be identified and eliminated. Is it because drug companies are subsidizing their low, controlled prices in other countries? Is it because of lack of competition? Is it because of the high cost of US approval?

3) A discussion and legal framework to help reduce the amount being spent on terminal care, while still providing high level care to those unfortunates who suffer grave illness or injury. This may necessitate a cultural change that allows people to pass away in old age, or a legal code that permits health care companies to provide plans that don't include terminal care, pushing the costs onto the individual and their families.

4) Some means of providing reasonable tort reform, to reduce the load on those professions where it is driving people out of business. This has to recognize that lawsuits serve an important function, but in recent years have become excessively penalizing.

Apparently we AREN'T getting what we're paying for according to a study done by John Hopkins University: http://www.csmonitor.com/2004/0505/p02s01-uspo.html





Our system can't be terribly efficient given the hodge podge of providers, polices etc...While we are apparently best in ER care, we fall down in just about every other stat. http://www.huppi.com/kangaroo/L-healthcare.htm








Well I think these payscales will speak loud and clear for your question about whether US doctors are overpaid compared to Doctors in other countries



Bear in mind the wage escalation since the time this data was accumulated (1991). I think it's a safe assumption that doctor's wages have increased significantly since then.





I tend to disagree with you on Tort reform as a panacea for what ails Healthcare in this country.... http://www.americanvoice2004.org/health/malpractice.html




I hate to say it but it strikes me that this for-profit driven healthcare machine we have not only ISN'T providing us with the best healthcare but seems to have led to a lack of accountability on the part of the industry and a level of greed that has more to do with the skyrocketing price of healthcare than malpractice settlements ever will.

IMO, we need Universal healthcare, as this mishmash of providers and policies drives up costs enormously.

We need to look at the salaries within the healthcare industry as it relates to doctors, nurses and the CEO's of these providers. This "whatever the market will bear" attitude may be fine in a general sense but it verges on blackmail when it comes to healthcare...They charge nose bleed amounts because they CAN.

American needs to STOP paying the price for drug R&D for the rest of the world and we also need to stop subsidizing those lower drug rates for the rest of the world. We're getting hosed HERE to make up for what the pharma industry precieves that they are losing ELSEWHERE.

Ah, the MishMash argument. The government would do a better job of providing insurance, because they wouldn't have to waste money on advertising and duplicating services.

No offense, but I'm not buying that argument. I doubt that you'd make that argument for food production and distribution, or housing, or for automobiles, or even education: do want the government choosing what major you'll study in college?

The government doesn't have a good track record of running things cheaply when they have a monopoly. Universal single payer healthcare would result in the creation of a Pharma-Medical complex that puts the Industrial-Military complex to shame.

The key to our inefficiency is a LACK of market forces: almost all private insurance is employer-provided.

I am all for universal healthcare, as long as it is market-based. The Swiss have a good model, we should copy it.

And The for-profit sectors been doing a bang up job of it????? I'm not advocating government run healthcare. I'm advocating universal guidelines and uniformed standardized coverage. I do disagree with the "Market driven" portion of your comments. We have a market driven healthcare system now and it ISN'T working. It costs farrrrrrrrrrr too much and provides farrrr too little (and for some people nothing at all).

Great links, Lin731.

SWM, I, too, usually would in principle agree that market forces will produce a more efficient system than any centrally-managed system. But we have to square with the fact that the current market based system is not working, and figure out what factors are causing that.

According to the Heartland Institute, the reason is the tax-exemption for employer-provided health care. It removes the consumer from decisions and favors plans designed for high-income individuals.

Also, found an interesting discussion on The Health Care Blog. He inks to an article in one post about how Health care competition may not result in better care. The study compared HEDIS scores, but as he points out, these scores are based on customer satisfaction with the plan, not with the care provided. More interesting is his very astute point. Competitive market selection for health care plans does not necessarily result in better care, because it doesn't necessarily result in a competitive market amongst health care providers. The consumer may shop around for the best plan, but ends up having to put up with whatever doctor is available.

[quote]Our system can't be terribly efficient given the hodge podge of providers, polices etc...While we are apparently best in ER care, we fall down in just about every other stat. [/quote]

He have a hodge podge of a lot of other services, are they necessarily in efficient? A hodge podge can promote efficiency and good service. It may be that health care, like some public industires, does not respond to normal market forces, and thus must be controlled. But the argument that variety causes inefficiency is not necessarily correct.

You are correct that poverty has a large role to play. But I am reminded that the number of uninsured in America is a lot larger than the number of "poor" in America. That points to a system broken in providing care to even lower-middle-income Americans.

[quote]Doctors' incomes: (2)

United States $132,300
Germany 91,244
Denmark 50,585
Finland 42,943
Norway 35,356
Sweden 25,768 [/quote]

Bear in mind the wage escalation since the time this data was accumulated (1991). I think it's a safe assumption that doctor's wages have increased significantly since then.
[/quote]

Okay. Why? We don't pay our doctors "too much" because of some law. Are there restrictive barriers to entry in our system relative to other nations? (a shortage of doctors? could this have to do with a failing education system... I love to return to that...hehehe) Are those salaries compensating for high insurance premiums... as many would argue. (I don't have data on this.)

[quote]I tend to disagree with you on Tort reform as a panacea for what ails Healthcare in this country.... [/quote]

No, we don't disagree. I'm sure it plays a role, maybe large in some fields like Ob/Gyn, but probably not for the system as a whole.

[quote]I hate to say it but it strikes me that this for-profit driven healthcare machine we have not only ISN'T providing us with the best healthcare but seems to have led to a lack of accountability on the part of the industry and a level of greed that has more to do with the skyrocketing price of healthcare than malpractice settlements ever will.[/quote]

To me, "lack of accountability" and even "level of greed" are things that point ot a broken market, not problems inherent in a functioning market system. The most competitive markets promote accountability and reduce profit margins.

The question is, can health care be an effective competitive market?

I recommend this summary of the swiss health care system. (pdf) Fascinating. (I need to finish reading it
to comment further.)

[quote]We need to look at the salaries within the healthcare industry as it relates to doctors, nurses and the CEO's of these providers. This "whatever the market will bear" attitude may be fine in a general sense but it verges on blackmail when it comes to healthcare...They charge nose bleed amounts because they CAN.[/quote] Or because they have to? Is it because they are compensating for pro bono care? Or because medical professionals' salaries are high because of a shortage of doctors, insurance premiums, or the high cost of medical education?

[quote]American needs to STOP paying the price for drug R&D for the rest of the world and we also need to stop subsidizing those lower drug rates for the rest of the world. We're getting hosed HERE to make up for what the pharma industry precieves that they are losing ELSEWHERE.[/quote]

True. How do we do this? It seems to me the only way to do this, until other countries are forced to pay higher rates, is to impose our own cost controls. I don't like it, but I don't know what else would work... to forec the companies to go back to other nations and demand higher caps.

Sigh.... like I said, so many different forces at work, it is difficult to put them all together.

Pudrick,
Thank you! It took some time to post all that info and I'm pleased that it was appreciated.



I think you're misunderstanding what I mean about "Hodge Podge" It's less about different coverages as it is about different forms and standards that apply to coverages. Let me give you an analogy:

I work for a major manufacturer of home improvement products, we sell our products to two major bigbox competetors. One costs more than the other, why? Vanity. One wants THEIR logo on the box so they can claim THEY make it, when in fact WE make it for both companies. The end results is higher costs to the one BigBox store because we have to rebox those parts into THEIR logo boxes, which is time, labor and space intensive, without those additional costs we could sell to BOTH at the same price. In every, other respect the process is the SAME, we manifest the orders the same, same shipper etc...In short the process is STANDARD to ALL the companies we supply parts to. The forms, parts and procedures, ALL the same. Now look at the healthcare industryyou have doctors offices dealing with 10 different providers, they're individual billing codes, procedure codes, claims forms, coverage exceptions etc... THAT drives up the costs ALOT. It's time, space, labor and materials intensive and THAT drives up the costs.



MY belief (and like you, presently I don't have data to support it) is that because we treat healthcare in the same manner we treat "widgets" is that doctors charge what the market will bear and in healthcare, the market will "bear" ALOT. You have a captive market really. It's like paying for gas, doesn't it seem that when one station hikes our lowers their prices, ALL the other stations, by in large do the same? Here you have sick people in need of medical treatment, IF they have insurance they're bound to use the providers covered under their policy. They can't doctor shop as they'd shop for a car or a DVD player, for the lowest price and really would you want to go to the cheapest doctor (particularly for a serious medical condition)? We're talking about your LIFE and your HEALTH here, it's not like buying a cheap toaster and it breaks in 6 months where you shrug it off and buy a better brand the next time. People are trapped within an industry that In MY opinion operates in collision with each other to gain the most profits (much like the oil industry). So people are stuck with whatever coverage their company provides and whatever amount of coverage it offers and whatever doctors work within their network.

Add to that, the fact that so many American have NO insurance at all and end up in ER's with serious illnesses that costs thousands to treat...Instead of paying 150.00 for an office call and 20 to 50 dollars for medications, WE'RE paying (and make no mistake, we ARE paying for it) thousands of dollars for an ambulance run, ER treatment and often hospitalizations for illnesses that if they had been treated at the onset would have cost a 10th of what it does when the illness progresses.

Yes it does. We pay more per capita than any other industrialized nation, yet many of us don't even have healthcare (I don't, in fact).

What can be done? Well, we can start by providing basic healthcare to every American. That will at least save us some money. I have a friend who racked up more than 100K in hospital bills and will be on disability for the rest of his life because his job didn't provide healthcare and he didn't have the money to go see a doctor about his sinuses. Aside from the fact that my friend is brain damaged (who would have thought your sinuses can back up into your brain and cause an infection?), he is also expensive. Not including his monthly disability payment, the cost of privatized healthcare in his case is that hospital bill, plus follow ups. In all his life, had he been able to see a doctor when he needed to, it's doubtful he would have run up even close to that amount. And guess who foots the bill for emergency care? We do.

S,

Actually, yes, the government could do a better job. Check out this article:

2004 Article



So you aren't buying the mishmash argument because I wouldn't make the argument for other situations? Maybe I would. The article does a fair job of making the case that universal health care would be cheaper than what we have now -- at minimum, costing about as much.

Selecting a college major requires being in college in the first place. No college, no major. No health insurance, no health care. So I'll argue that it is better to have some college and some health care than nothing.



Medicare has only a 4% overhead versus 12% (average) for private insurers, from the above article. I've seen this comparison elsewhere, and thus I doubt the unsubstantiated claim that the government doesn't have a good track record in health care. Looks like the government does better than the private sector when it comes to health care.



No, most health care costs money that the employer pays to separate insurance companies. There are plenty of these outfits: Second, The United States' fragmented payment system drives up administrative costs for doctors and hospitals, who must deal with hundreds of different insurance plans (for example, at least 755 in Seattle alone), each with different coverage and payment rules, referral networks, etc. [from the article]

I have seen this first hand when working for a hospital as a systems admin. I knew the finance department manager pretty well. We had an AS400 to do just the billing, and this wasn't a huge hospital. About average sized.



Please provide a link to some background on the Swiss model. I like the army knives and might like this model as well.

Meanwhile, our health care situation is in dire need for reform. The market-based American model is a failure. We need to face this and change it for the better. The above article is a good starting point, plus the study that the article references was done by actual doctors. I think we ought to listen to the health care pros, not the CEOs of HMOs.

AuthorMusician, see my last post for a link to a summary of the swiss system.

As much of a fan of free markets as I am, I am beginning to think that perhaps health care is just one of those industries that doesn't respond to market forces. Lin327 makes some good points.

And while, as Neal Boortz likes to point out, nobody has a RIGHT to health care, it really seems to be in the public interest to have universal coverage of some sort or another, because it is a lot more expensive to society than the alternative.

However, I don't think universal coverage necessarily has to be completely government managed and operated.

Perhaps an way to ensure universal coverage while preserving a pseudo-market would be a baseline health "insurance" program, tax-funded, that permits some level of provider choice. You couldn't "vote with your dollars," but you could at least "vote with your feet."